Provider Demographics
NPI:1750332672
Name:JORDAN, HOPE C (DO)
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:C
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 SEA LN
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:IN
Mailing Address - Zip Code:46506-9389
Mailing Address - Country:US
Mailing Address - Phone:574-248-0365
Mailing Address - Fax:
Practice Address - Street 1:310 N IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615
Practice Address - Country:US
Practice Address - Phone:574-287-6333
Practice Address - Fax:574-287-5651
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001289A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN179250EMedicare ID - Type Unspecified
F39111Medicare UPIN