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General NPI Number Information
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NPI Number | 1750340063
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Entity Type | Individual
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Provider Name | OAKLEY C JORDAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 740 BARTLETT RD
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City | MEMPHIS
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State | TN
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Zip | 38122-3004
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Country | US
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Telephone | 901-685-8202
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Fax | 901-682-3525
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Provider Business Mailing Address
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Address Line | 764 WALNUT KNOLL LN
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City | CORDOVA
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State | TN
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Zip | 38018-3113
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Country | US
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Telephone | 901-756-5565
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Fax | 901-756-5564
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 11264
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License Number State | TN
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