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Individual
DR. WADE THOMAS JORDAN
Active
Individual
DR. WADE THOMAS JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M..D.
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
R4P99
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002012599
MEDICARE PTAN
MO
05
—
122036001
—
AR
01
—
153509
HEALTHLINK
—
05
—
203047915
—
MO
01
—
25183
BLUE CROSS BLUE SHIELD
MO
01
—
390003925
RAILROAD MEDICARE
—
Enumeration date
10/06/2006
Last updated
12/01/2009
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