Individual
DR. JORDAN C PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-9729
(417) 820-6471
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
115372
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148982003
—
AR
01
—
173098
MO BLUE SHIELD
MO
05
—
245988407
—
MO
01
—
99402
ARK BLUE SHIELD
AR
Enumeration date
02/02/2007
Last updated
05/09/2013
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