Provider Demographics
NPI:1376655126
Name:JORDAN, ARTHUR J JR (DO)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:J
Last Name:JORDAN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MIFFLIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-342-3145
Mailing Address - Fax:570-344-1309
Practice Address - Street 1:200 MIFFLIN AVENUE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503
Practice Address - Country:US
Practice Address - Phone:570-342-3145
Practice Address - Fax:570-344-1309
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009313L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
44822OtherGELSINGER HEALTH PLAN
JO553727OtherHIGH MARK BLUE SHIELD
PA01617945Medicaid
180035592OtherRAILROAD MEDICARE
506554OtherAETNA
808622OtherFIRST PRIORITY HEALTH
PA553727Medicare ID - Type Unspecified
PA01617945Medicaid