Individual
MRS. BROOKE LEANN JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-3431
Mailing address
2901 BLEDSOE ST, APT 2493, FORT WORTH, TX 76107-1810
(817) 291-4505
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
Q8521
TX
390200000X
Student in an Organized Health Care Education/Training Program
573164
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q8521
MEDICAL LICENSE
TX
Enumeration date
04/24/2013
Last updated
07/07/2016
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