Individual
RICHARD MONTGOMERY JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 SUMMIT CROSSING PL, SUITE 106, GASTONIA, NC 28054-2176
(704) 867-8021
(704) 864-4606
Mailing address
620 SUMMIT CROSSING PL, SUITE 106, GASTONIA, NC 28054-2176
(704) 867-8021
(704) 864-4606
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
30923
NC
2085R0204X
Vascular & Interventional Radiology Physician
Primary
30923
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1642994
UNITED HEALTHCARE
—
01
—
2137652
AETNA HMO
—
01
—
300068233
RAILROAD MEDICARE
—
01
—
4629496
AETNA PPO
—
01
—
47484
BLUE CROSS BLUE SHIELD
—
01
—
6677
PARTNERS
—
01
—
72386
MEDCOST
—
05
—
8947484
—
NC
05
—
N30923
—
SC
Enumeration date
12/23/2005
Last updated
08/23/2010
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