Individual
MR. GLEN S. JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1340 HAL GREER BLVD, HUNTINGTON, WV 25701-3804
(304) 399-6727
(304) 399-6726
Mailing address
1340 HAL GREER BLVD, HUNTINGTON, WV 25701-3804
(304) 399-6727
(304) 399-6726
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
01222
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0080124
—
OH
05
—
1790885341
—
WV
05
—
7100118540
—
KY
01
—
P00711764
MEDICARE RR
WV
Enumeration date
09/24/2006
Last updated
04/13/2021
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