Individual
SHANE JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1285 BEACON ST, BROOKLINE, MA 02446-5284
(617) 751-6205
Mailing address
304 WINTER ST, NORWELL, MA 02061-1402
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA6034
MA
Other
Enumeration date
02/07/2017
Last updated
02/07/2017
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