Provider Demographics
NPI:1588814107
Name:PAUL-JORDAN, PHYLLIS DENINE (MD)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:DENINE
Last Name:PAUL-JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N HOPE ST RM 538
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2607
Mailing Address - Country:US
Mailing Address - Phone:213-367-2001
Mailing Address - Fax:
Practice Address - Street 1:111 N HOPE ST RM 538
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2607
Practice Address - Country:US
Practice Address - Phone:213-367-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG765132083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine