Provider Demographics
NPI:1003808528
Name:JORDAN, JENNIFER ANN (MD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 BEACHVIEW ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3700
Mailing Address - Country:US
Mailing Address - Phone:214-324-0418
Mailing Address - Fax:214-324-0693
Practice Address - Street 1:1130 BEACHVIEW ST
Practice Address - Street 2:SUITE 240
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3700
Practice Address - Country:US
Practice Address - Phone:214-324-0418
Practice Address - Fax:214-324-0693
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9721174400000X, 207YP0228X, 207YS0012X, 207Y00000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87470NMedicare ID - Type Unspecified
TXG85046Medicare UPIN