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NPI Code Detail

MEDICARE: JORDAN JUSTICE HARBAUGH-WILLIAMS MD

MEDICARE: JORDAN JUSTICE HARBAUGH-WILLIAMS 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
1207Q00000XFamily Medicine Physician16015AWY

General Provider Information

NPI Number : 1831753938
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN JUSTICE HARBAUGH-WILLIAMS MD
Provider Business Mailing Address
First Line : 14 GREAT PLAINS RD
Second Line :
City : ARAPAHOE
State : WY
Zip : 82510-9144
Country : US
Telephone Number : 307-856-9281
Fax Number :
Provider Business Practice Location Address
First Line : 14 GREAT PLAINS RD
Second Line :
City : ARAPAHOE
State : WY
Zip : 82510-9144
Country : US
Telephone Number : 307-856-9281
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2019
Last Update Date : 11/07/2023

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