Provider Demographics
NPI:1972751543
Name:JORDAN, RICHARD RAY (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:RAY
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73265
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77273-3265
Mailing Address - Country:US
Mailing Address - Phone:281-580-9030
Mailing Address - Fax:281-580-2725
Practice Address - Street 1:1017 S TRAVIS AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-5152
Practice Address - Country:US
Practice Address - Phone:284-580-9030
Practice Address - Fax:281-580-2725
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3505207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-3248738OtherTAX ID #