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Individual

DEAN D JORDAN

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1122 NE 2ND ST, CORVALLIS, OR 97330-6227
(541) 754-2700
(541) 754-2707
Mailing address
1122 NE 2ND ST, CORVALLIS, OR 97330-6227
(541) 754-2700
(541) 754-2707

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00073
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
133948
OR
Enumeration date
10/11/2005
Last updated
07/09/2007
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