Provider Demographics
NPI:1417243668
Name:SAND, JORDAN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:PAUL
Last Name:SAND
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 1:307 W 6TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2502
Mailing Address - Country:US
Mailing Address - Phone:093-242-9805
Mailing Address - Fax:094-189-4625
Practice Address - Street 1:307 W 6TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2502
Practice Address - Country:US
Practice Address - Phone:509-324-2980
Practice Address - Fax:094-189-4625
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60681545207YS0123X, 207Y00000X
CAA140770207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery