Individual
LAUREN ELIZABETH JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
350 W THOMAS RD, ATTN: ACADEMIC AFFAIRS, PHOENIX, AZ 85013-4409
(602) 406-3538
Mailing address
9961 SIERRA AVE, FONTANA, CA 92335-6720
(888) 956-1616
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
72492
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
72492
TRAINING PERMIT
AZ
Enumeration date
06/21/2011
Last updated
10/25/2021
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