Provider Demographics
NPI:1528009693
Name:JORDAN, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:JORDAN
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:STE H
Mailing Address - Street 2:1201 S DOUGLAS BLVD
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5263
Mailing Address - Country:US
Mailing Address - Phone:405-732-7777
Mailing Address - Fax:405-610-7785
Practice Address - Street 1:1201 S DOUGLAS BLVD
Practice Address - Street 2:STE H
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5263
Practice Address - Country:US
Practice Address - Phone:405-732-7777
Practice Address - Fax:405-610-7785
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21723207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00065173OtherRAILROAD MEDICARE
OKA002OtherTRICARE
OK4863400001Medicare NSC
OKA002OtherTRICARE