Provider Demographics
NPI:1245734409
Name:MINISH-PRON, JORDAN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARIE
Last Name:MINISH-PRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:MARIE
Other - Last Name:MINISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7012 CHULA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2761
Mailing Address - Country:US
Mailing Address - Phone:850-324-4744
Mailing Address - Fax:352-265-1107
Practice Address - Street 1:1720 2ND AVENUE SOUTH THT422
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-3003
Practice Address - Country:US
Practice Address - Phone:205-996-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program