MEDICARE: DR. FRANK EDWIN JORDAN M.D.

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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	MD14614	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1841286853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK EDWIN JORDAN M.D.

Provider Business Mailing Address
First Line	:	23 WINDWOOD DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-8835
Country	:	US
Telephone Number	:	731-664-8126
Fax Number	:	731-660-5119

Provider Business Practice Location Address
First Line	:	160C W UNIVERSITY PKWY
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-1667
Country	:	US
Telephone Number	:	731-660-5116
Fax Number	:	731-554-0306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	08/14/2015

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