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Individual
WILLIAM J JORDAN
Active
Individual
WILLIAM J JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601001389
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N61290008
MEDICARE PLUS BLUE-MEDICARE ADVANTAGE
—
01
—
1153313120
BLUE CROSS BLUE SHIELD
MI
Enumeration date
10/20/2006
Last updated
06/20/2019
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