Provider Demographics
NPI:1679523625
Name:JORDAN, CHRISTOPHER GRIFFITH (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GRIFFITH
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 CLEARFORK MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3562
Mailing Address - Country:US
Mailing Address - Phone:682-707-4545
Mailing Address - Fax:817-804-8160
Practice Address - Street 1:5450 CLEARFORK MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3562
Practice Address - Country:US
Practice Address - Phone:682-707-4545
Practice Address - Fax:817-804-8160
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1085207RH0003X, 207RX0202X
ALDO-986207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1500738-01Medicaid
TX1500738-02Medicaid
TX150073803Medicaid
TX8EF297OtherBCBS
AL009913293Medicaid
TX1500738-01Medicaid
AL009913293Medicaid
TX1500738-02Medicaid
H55872Medicare UPIN
TX8EF297OtherBCBS
TX292911YS7YMedicare PIN