Provider Demographics
NPI:1427357375
Name:DONNA JORDAN, D.O.,P.A.
Entity Type:Organization
Organization Name:DONNA JORDAN, D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:325-698-8500
Mailing Address - Street 1:23 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5270
Mailing Address - Country:US
Mailing Address - Phone:325-698-8500
Mailing Address - Fax:325-698-8631
Practice Address - Street 1:23 HOSPITAL DR
Practice Address - Street 2:STE. 100
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5270
Practice Address - Country:US
Practice Address - Phone:325-698-8500
Practice Address - Fax:325-698-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty