Provider Demographics
NPI:1851385439
Name:JORDAN THOMAS, JUDY SHARON (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:SHARON
Last Name:JORDAN THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:SHARON
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6926 WASHITA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2308
Mailing Address - Country:US
Mailing Address - Phone:210-698-2388
Mailing Address - Fax:
Practice Address - Street 1:6926 WASHITA WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-2308
Practice Address - Country:US
Practice Address - Phone:210-698-2388
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4974207N00000X
NC39832207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology