Provider Demographics
NPI:1821179029
Name:JORDAN, JAMES L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:331 HOSPITAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-9217
Practice Address - Country:US
Practice Address - Phone:417-532-3495
Practice Address - Fax:417-532-3598
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20001603582083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205006406Medicaid
MOB59027Medicare UPIN
MO205006406Medicaid
MO132300590Medicare PIN
MO261013268Medicare PIN