Provider Demographics
NPI:1104851096
Name:JORDAN, RAYMOND F (DO)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:F
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4002 TECHNOLOGY CTR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2697
Mailing Address - Country:US
Mailing Address - Phone:903-247-0484
Mailing Address - Fax:903-247-0485
Practice Address - Street 1:103 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-3115
Practice Address - Country:US
Practice Address - Phone:903-882-3194
Practice Address - Fax:903-882-7405
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ0842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF00834Medicare UPIN