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NPI Code Detail

MEDICARE: JORDAN BRZEZNY

MEDICARE: JORDAN BRZEZNY
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 PhysicianW4771TX

General Provider Information

NPI Number : 1487223178
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN BRZEZNY
Provider Business Mailing Address
First Line : 1501 KINGS HWY
Second Line :
City : SHREVEPORT
State : LA
Zip : 71103-4228
Country : US
Telephone Number : 318-626-0434
Fax Number :
Provider Business Practice Location Address
First Line : 6201 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75235-5202
Country : US
Telephone Number : 214-648-2122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2021
Last Update Date : 05/19/2026

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Directions to “ JORDAN BRZEZNY ” Practice Location

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