Provider Demographics
NPI:1003974254
Name:JORDAN, ERIC L (CPED)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 WEST LOUIS HENNA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728
Mailing Address - Country:US
Mailing Address - Phone:512-244-9780
Mailing Address - Fax:512-244-9936
Practice Address - Street 1:399 WEST LOUIS HENNA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728
Practice Address - Country:US
Practice Address - Phone:512-244-9780
Practice Address - Fax:512-244-9936
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32011479873174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist