Individual
DR. JORDAN BLAINE COULSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1900 N HIGLEY RD, GILBERT, AZ 85234-1604
(480) 543-2034
(480) 543-2647
Mailing address
1900 N HIGLEY RD, GILBERT, AZ 85234-1604
(480) 543-2034
(480) 543-2647
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
43356
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/21/2007
Last updated
11/18/2010
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