MEDICARE: ROBERT E JORDON 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	G7032	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87X445	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1174570204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT E JORDON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 201088
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77216-1088
Country	:	US
Telephone Number	:	713-500-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	6655 TRAVIS ST
Second Line	:	600
City	:	HOUSTON
State	:	TX
Zip	:	77030-1312
Country	:	US
Telephone Number	:	713-500-8260
Fax Number	:	713-524-3432

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	12/19/2007

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