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General NPI Number Information
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NPI Number | 1861851651
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Entity Type | Organization
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Legal Business Name | JORDAN PHYSICIAN ASSOCIATES, INC.
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 275 SANDWICH ST
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City | PLYMOUTH
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State | MA
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Zip | 02360-2183
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Country | US
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Telephone | 508-746-2000
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Fax | 508-830-1131
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Provider Business Mailing Address
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Address Line | 275 SANDWICH ST
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City | PLYMOUTH
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State | MA
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Zip | 02360-2183
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Country | US
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Telephone | 508-746-2000
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Fax | 508-830-1131
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | CATHERINE J GREY
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Credential |
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Telephone | 508-830-2401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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