Provider Demographics
NPI:1437349420
Name:JORDAN, WILLIAM JEFFERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEFFERSON
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 VISION PARK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3030
Mailing Address - Country:US
Mailing Address - Phone:936-242-1437
Mailing Address - Fax:
Practice Address - Street 1:134 VISION PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3030
Practice Address - Country:US
Practice Address - Phone:936-242-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5135207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX343719YZU3Medicare PIN