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NPI Code Detail

MEDICARE: DR. ROBERT CHARLES JORDAN M.D., F.A.A.O.A.

MEDICARE: DR. ROBERT CHARLES JORDAN M.D., F.A.A.O.A.
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
1207Y00000XOtolaryngology Physician10476SC

Other Identifiers

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

General Provider Information

NPI Number : 1558367433
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT CHARLES JORDAN M.D., F.A.A.O.A.
Provider Business Mailing Address
First Line : 2295 HENRY TECKLENBURG DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-7801
Country : US
Telephone Number : 843-766-7103
Fax Number : 843-873-8732
Provider Business Practice Location Address
First Line : 2295 HENRY TECKLENBURG DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-7801
Country : US
Telephone Number : 843-766-7103
Fax Number : 843-873-8732
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2005
Last Update Date : 10/19/2016

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