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Individual
JORDAN ROBERT MOE
Active
Individual
JORDAN ROBERT MOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
52007
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-37339
MEDICA
—
01
—
1033386966
BCBS
MN
01
—
1033386966
GROUP HEALTH
WI
05
—
1033386966
—
MN
01
—
P00767161
RAILROAD MEDICARE
—
Enumeration date
05/09/2008
Last updated
12/14/2011
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