Provider Demographics
NPI:1972892867
Name:JORDAN, MATTHEW DOUGLAS (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DOUGLAS
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 WALNUT HILL LN STE 830
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4426
Mailing Address - Country:US
Mailing Address - Phone:214-345-7999
Mailing Address - Fax:214-345-7942
Practice Address - Street 1:8200 WALNUT HILL LN STE 830
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4426
Practice Address - Country:US
Practice Address - Phone:214-345-7999
Practice Address - Fax:214-345-7942
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13050207R00000X
LADO.000313207R00000X, 208M00000X
TXR7778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLWILL SUBMITOtherRAILROAD MEDICARE
FL014712200Medicaid
LA2150626Medicaid
LA2150626Medicaid
FLWILL SUBMITOtherRAILROAD MEDICARE