Provider Demographics
NPI:1174263420
Name:COFFEY, JORDAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:COFFEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 ALLARD BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3739
Mailing Address - Country:US
Mailing Address - Phone:585-967-4688
Mailing Address - Fax:
Practice Address - Street 1:4228 HOUMA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3004
Practice Address - Country:US
Practice Address - Phone:504-454-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program