Provider Demographics
NPI:1922430842
Name:JORDAN, JAMES VINCENT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VINCENT
Last Name:JORDAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3648 DUCHESS CT
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1404
Mailing Address - Country:US
Mailing Address - Phone:630-515-1073
Mailing Address - Fax:630-515-1073
Practice Address - Street 1:3648 DUCHESS CT
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1404
Practice Address - Country:US
Practice Address - Phone:630-515-1073
Practice Address - Fax:630-515-1073
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036052392207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052392OtherMEDICAL LICENSE NUMBER