Individual
DAVID W JORDAN
Active
Individual
DAVID W JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4325
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000012340
BLUE CROSS BLUE SHIELD
MT
05
—
055094
—
MT
01
—
9989778
MEDICAID PASSPORT
MT
01
—
P00089863
PALMETTO GBA
—
Enumeration date
10/21/2005
Last updated
07/21/2009
Update your record
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