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NPI Code Detail

MEDICARE: ROBERT BRUCE JORDAN MD

MEDICARE: ROBERT BRUCE JORDAN MD
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
12085R0202XDiagnostic Radiology PhysicianC26156CA
22085R0202XDiagnostic Radiology PhysicianMD.009180LA
32085R0202XDiagnostic Radiology PhysicianJ1277TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316988900
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT BRUCE JORDAN MD
Provider Business Mailing Address
First Line : PO BOX 7146
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71306-0146
Country : US
Telephone Number : 805-901-0204
Fax Number : 318-443-2410
Provider Business Practice Location Address
First Line : 253 WILDERNESS DR
Second Line :
City : BOYCE
State : LA
Zip : 71409-8618
Country : US
Telephone Number : 318-443-2418
Fax Number : 318-443-2410
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 07/07/2009

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