Individual
JORDAN V LAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
88 E NEWTON ST, BOSTON, MA 02118-2308
(617) 638-6610
Mailing address
8401 DATAPOINT, SUITE 600, P. O. BOX 29441, SAN ANTONIO, TX 78229-0441
(210) 616-7796
(210) 616-7799
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
Q7911
TX
390200000X
Student in an Organized Health Care Education/Training Program
244666
MA
Other
Enumeration date
06/14/2010
Last updated
05/06/2016
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