Provider Demographics
NPI:1184226888
Name:ORR, JORDAN (PA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:ORR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7943 MOFFETT RD
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-5409
Mailing Address - Country:US
Mailing Address - Phone:251-633-0123
Mailing Address - Fax:251-445-3722
Practice Address - Street 1:7943 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5409
Practice Address - Country:US
Practice Address - Phone:251-633-0123
Practice Address - Fax:251-445-3722
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1692363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant