Individual
MR. JEREMY TODD JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MBA
Contact information
Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1297
(304) 388-5432
Mailing address
2300 MACCORKLE AVE SE, CHARLESTON, WV 25304-1099
(304) 357-4790
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
823
WV
Other
Enumeration date
06/15/2006
Last updated
08/03/2021
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