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General NPI Number Information
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NPI Number | 1659934917
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Entity Type | Individual
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Provider Name | JORDAN THOMAS PHARRIS DO
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Gender | Male
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 1238 S MAIN ST
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City | MORGANTOWN
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State | KY
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Zip | 42261-7234
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Country | US
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Telephone | 270-526-3137
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Fax | 270-526-4829
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Provider Business Mailing Address
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Address Line | PO BOX 148
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City | HARTFORD
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State | KY
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Zip | 42347-0148
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Country | US
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Telephone | 702-504-1910
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Fax | 270-298-3824
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 05358
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License Number State | KY
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