Individual
PHILLIP JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 GRESHAM DR, RALEIGH BUILDING, SUITE 304, NORFOLK, VA 23507-1904
(757) 388-3397
(757) 388-2885
Mailing address
6379 CENTER DR, NORFOLK, VA 23502-4102
(757) 388-3397
(757) 388-2885
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101269116
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2017
Last updated
06/19/2020
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