Individual
MARSHALL C JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
ESPANOLA MULTI-SPECIALTY CLINIC, 1010 SPRUCE ST, ESPANOLA, NM 87532
(505) 367-0340
(505) 367-0346
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD2006-0824
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
29377056
—
NM
Enumeration date
05/17/2006
Last updated
08/14/2008
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