MEDICARE: JORDAN WILLIAM WARD

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1174874168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN WILLIAM WARD

Provider Business Mailing Address
First Line	:	1636 REGULUS AVE
Second Line	:	ATTN: NOOM
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23461-2200
Country	:	US
Telephone Number	:	402-389-0788
Fax Number	:

Provider Business Practice Location Address
First Line	:	1636 REGULUS AVE
Second Line	:	ATTN: NOOM
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23461-2200
Country	:	US
Telephone Number	:	402-389-0788
Fax Number	:

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

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	10/01/2012

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