Individual
JORDAN THIESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 N STATE ST, DEPARTMENT OF EMERGENCY MEDICINE, JACKSON, MS 39216
(601) 984-5582
(601) 984-5583
Mailing address
2500 N STATE ST, DEPARTMENT OF EMERGENCY MEDICINE, JACKSON, MS 39216-4500
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
20A16372
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07087533
—
MS
Enumeration date
05/19/2015
Last updated
07/11/2018
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