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Individual
JORDAN LICATA
Active
Individual
JORDAN LICATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
05799
KY
207Y00000X
Otolaryngology Physician
Primary
5294
TN
Other
Enumeration date
03/26/2015
Last updated
12/12/2024
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