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NPI Code Detail

MEDICARE: LAUREL JORDAN DO

MEDICARE: LAUREL JORDAN DO
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
1207V00000XObstetrics & Gynecology Physician34008645OH

General Provider Information

NPI Number : 1720188493
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREL JORDAN DO
Provider Business Mailing Address
First Line : 530 N MONTE VISTA ST
Second Line : SUITE A
City : ADA
State : OK
Zip : 74820-4675
Country : US
Telephone Number : 580-436-7101
Fax Number : 580-436-4447
Provider Business Practice Location Address
First Line : 2020 ARLINGTON
Second Line : SUITE 2
City : ADA
State : OK
Zip : 74820-2822
Country : US
Telephone Number : 580-436-9037
Fax Number : 580-436-9028
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2006
Last Update Date : 10/29/2014

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