MEDICARE: JORDAN RENEE DREILING PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant
2	363AS0400X	Surgical Physician Assistant	PA.0008792	CO
3	363A00000X	Physician Assistant	PA07508	TX

General Provider Information

NPI Number	:	1023387222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN RENEE DREILING PA-C

Provider Business Mailing Address
First Line	:	1935 MEDICAL DISTRICT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7701
Country	:	US
Telephone Number	:	214-456-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 MEDICAL DISTRICT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7701
Country	:	US
Telephone Number	:	214-456-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2011
Last Update Date	:	12/08/2025

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