Provider Demographics
NPI:1790227957
Name:JORDAN, GARY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:JORDAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7272 WURZBACH RD
Mailing Address - Street 2:SUITE 706
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4801
Mailing Address - Country:US
Mailing Address - Phone:210-615-3483
Mailing Address - Fax:210-593-9863
Practice Address - Street 1:7272 WURZBACH RD
Practice Address - Street 2:SUITE 706
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4801
Practice Address - Country:US
Practice Address - Phone:210-615-3483
Practice Address - Fax:210-593-9863
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX22431103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22431OtherLICENSE