MEDICARE: JORDAN LYNN WHATLEY M.D.

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	207N00000X	Dermatology Physician	MD.201860	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063603397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN LYNN WHATLEY M.D.

Provider Business Mailing Address
First Line	:	5326 ODONOVAN DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4691
Country	:	US
Telephone Number	:	225-769-7546
Fax Number	:	225-769-0471

Provider Business Practice Location Address
First Line	:	5326 ODONOVAN DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4691
Country	:	US
Telephone Number	:	225-769-7546
Fax Number	:	225-769-0471

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

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	03/17/2017

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