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NPI Code Detail

MEDICARE: DONNA MICHELLE JORDAN D.O.

MEDICARE: DONNA MICHELLE JORDAN D.O.
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
1207Q00000XFamily Medicine PhysicianK2930TX

General Provider Information

NPI Number : 1518990464
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA MICHELLE JORDAN D.O.
Provider Business Mailing Address
First Line : 23 HOSPITAL DR
Second Line : SUITE 100
City : ABILENE
State : TX
Zip : 79606-5270
Country : US
Telephone Number : 325-698-8500
Fax Number : 325-698-8631
Provider Business Practice Location Address
First Line : 23 HOSPITAL DR
Second Line : SUITE 100
City : ABILENE
State : TX
Zip : 79606-5270
Country : US
Telephone Number : 325-698-8500
Fax Number : 325-698-8631
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 07/08/2007

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