Individual
DAKEYA V JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2440
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
P4465
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
337803601
—
TX
01
—
8EL277
BCBS
TX
01
—
P01398102
RAILROAD MEDICARE
TX
Enumeration date
07/08/2009
Last updated
03/02/2015
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