Individual
DR. KEVIN MITCHELL JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9040 JACKSON, TACOMA, WA 98431-5001
(253) 968-5509
Mailing address
1363 ABERDEEN AVE, WSMR, NM 88002
(575) 674-3500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28248
NE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/06/2013
Last updated
10/14/2020
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