Individual
DR. EARL LAWRENCE JORDAN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2630 CUNNINGHAM AVE, JOPLIN, MO 64804-1542
(417) 781-0044
(417) 781-6331
Mailing address
2630 CUNNINGHAM AVE, JOPLIN, MO 64804-1542
(417) 781-0044
(417) 781-6331
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
0521009
KS
207W00000X
Ophthalmology Physician
Primary
R7D82
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100026260A
—
OK
05
—
100229750B
—
KS
05
—
100229750C
—
KS
01
—
106030
BLUE CROSS/BLUE SHIELD
KS
01
—
180027096
RAILROAD MEDICARE
MO
01
—
180027097
RAILROAD MEDICARE
KS
05
—
241986504
—
MO
Enumeration date
10/20/2006
Last updated
02/23/2015
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