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Individual

DR. WADE THOMAS JORDAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M..D.

Contact information

Practice address
1911 S NATIONAL AVE, SUITE 301, SPRINGFIELD, MO 65804-2219
(417) 886-5000
(417) 886-1100
Mailing address
1911 S NATIONAL AVE, SUITE 301, SPRINGFIELD, MO 65804-2219
(417) 886-5000
(417) 886-1100

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
R4P99
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
002012599
MEDICARE PTAN
MO
05
122036001
AR
01
153509
HEALTHLINK
05
203047915
MO
01
25183
BLUE CROSS BLUE SHIELD
MO
01
390003925
RAILROAD MEDICARE
Enumeration date
10/06/2006
Last updated
12/01/2009
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