MEDICARE: BLAIR PHILIP 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
1	208600000X	Surgery Physician	F8180	TX

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	:	1457448490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAIR PHILIP JORDAN MD

Provider Business Mailing Address
First Line	:	508 MEDICAL CENTER BLVD
Second Line	:	STE 200
City	:	CONROE
State	:	TX
Zip	:	77304-2953
Country	:	US
Telephone Number	:	936-760-4600
Fax Number	:	936-760-4601

Provider Business Practice Location Address
First Line	:	508 MEDICAL CENTER BLVD
Second Line	:	STE 200
City	:	CONROE
State	:	TX
Zip	:	77304-2953
Country	:	US
Telephone Number	:	936-760-4600
Fax Number	:	936-760-4601

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	02/09/2022

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Directions to “ BLAIR PHILIP JORDAN MD” Practice Location

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