Individual
JORDAN ROBERT MOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
49725 COUNTY 83, STAPLES, MN 56479-5280
(218) 894-1515
Mailing address
49725 COUNTY 83, STAPLES, MN 56479-5280
(218) 894-1515
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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