Individual
MARLON D JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1418 COLLEGE DR, MOUNT CARMEL, IL 62863-2638
(618) 240-2740
(618) 263-6479
Mailing address
1418 COLLEGE DR, MOUNT CARMEL, IL 62863-2638
(618) 240-2740
(618) 263-6479
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
01030224A
IN
207RC0000X
Cardiovascular Disease Physician
Primary
036082355
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042524
ANTHEM
—
05
—
100343920A
—
IN
05
—
64756620
—
KY
Enumeration date
04/11/2006
Last updated
02/17/2022
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