Individual
MR. TAWAN JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
750 E I 10 SERVICE RD STE G, SLIDELL, LA 70461-5535
(504) 228-7853
(504) 326-6513
Mailing address
1008 MCCARTNEY CT, SLIDELL, LA 70461-4844
(504) 228-7836
(985) 326-6513
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
LA
Other
Enumeration date
07/30/2018
Last updated
07/30/2018
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