Individual
MICHAEL JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(512) 947-0552
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
BP10040566
TX
207P00000X
Emergency Medicine Physician
Primary
P5824
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP10040566
PHYSICIAN IN TRAINING PERMIT
TX
Enumeration date
05/05/2011
Last updated
06/26/2013
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