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NPI Code Detail

MEDICARE: LOUIS C JORDAN M.D.

MEDICARE: LOUIS C JORDAN 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
1207XS0114XAdult Reconstructive Orthopaedic Surgery Physician0101057969VA
2207XX0005XSports Medicine (Orthopaedic Surgery) Physician0101057969VA
3207X00000XOrthopaedic Surgery Physician0101057969VA

General Provider Information

NPI Number : 1316976632
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOUIS C JORDAN M.D.
Provider Business Mailing Address
First Line : 5716 CLEVELAND ST
Second Line : SUITE 200
City : VIRGINIA BEACH
State : VA
Zip : 23462-1784
Country : US
Telephone Number : 757-502-8570
Fax Number : 757-961-9767
Provider Business Practice Location Address
First Line : 5716 CLEVELAND ST
Second Line : SUITE 200
City : VIRGINIA BEACH
State : VA
Zip : 23462-1784
Country : US
Telephone Number : 757-502-8570
Fax Number : 757-961-9767
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 04/18/2023

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Directions to “ LOUIS C JORDAN M.D.” Practice Location

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