Individual
BRIAN JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10800 KNIGHTS RD, PHILADELPHIA, PA 19114-4200
(215) 612-5161
Mailing address
10800 KNIGHTS RD, PHILADELPHIA, PA 19114-4200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
OS021055
PA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
OT019502
PA
Other
Enumeration date
06/20/2019
Last updated
08/26/2024
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