Provider Demographics
NPI:1164834206
Name:BRICE, JORDAN AUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:AUSTIN
Last Name:BRICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52448
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-2448
Mailing Address - Country:US
Mailing Address - Phone:318-797-1743
Mailing Address - Fax:318-797-7599
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-797-1743
Practice Address - Fax:318-797-7599
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA308352207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology