Individual
EDMOND R JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
895 TIGER BLVD, CLEMSON, SC 29631-1480
(864) 654-6800
(864) 654-7672
Mailing address
885 TIGER BLVD, CLEMSON, SC 29631-1480
(864) 654-6800
(864) 654-7672
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11861
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010056135
RAILROAD MEDICARE
—
05
—
118615
—
SC
01
—
26142
MEDCOST
—
01
—
6603937
CAROLINA CARE PLAN
—
Enumeration date
04/13/2006
Last updated
01/18/2018
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