Provider Demographics
NPI:1598845521
Name:JORDAN, FRANCIS ROBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:ROBERT
Last Name:JORDAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FRANCIS
Other - Middle Name:ROBERT
Other - Last Name:JORDAN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 14832
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212
Mailing Address - Country:US
Mailing Address - Phone:518-459-0711
Mailing Address - Fax:518-640-1690
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1004
Practice Address - Country:US
Practice Address - Phone:518-459-0711
Practice Address - Fax:518-640-1690
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101633208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00527371Medicaid
NYD73981Medicare UPIN
NY00527371Medicaid