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General NPI Number Information
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NPI Number | 1801824917
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Entity Type | Individual
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Provider Name | WILLIAM JORDAN PHELAN P.A.-C.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | VA CLINIC, 1607 ST JAMES COURT
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City | TALLAHASSEE
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State | FL
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Zip | 32308
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Country | US
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Telephone | 850-878-0191
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Fax | 850-219-2704
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Provider Business Mailing Address
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Address Line | 9601-20 MICCOSUKEE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32309-9662
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Country | US
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Telephone | 850-878-0191
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Fax | 850-219-2704
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 9103039
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License Number State | FL
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