Individual
JORDAN SAMUEL DEHAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1180 HOPE ST, BRISTOL, RI 02809-1126
(401) 253-8900
(401) 253-3131
Mailing address
1180 HOPE ST, BRISTOL, RI 02809-1126
(401) 253-8900
(401) 253-3131
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DPM00328
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
JD81548
—
RI
Enumeration date
07/09/2009
Last updated
07/23/2025
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