Provider Demographics
NPI:1982679452
Name:JORDAN, CARL CAREY (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:CAREY
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:740 HOSPITAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4664
Mailing Address - Country:US
Mailing Address - Phone:409-212-8111
Mailing Address - Fax:409-981-1787
Practice Address - Street 1:740 HOSPITAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4664
Practice Address - Country:US
Practice Address - Phone:409-212-8111
Practice Address - Fax:409-981-1787
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2734207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134062202Medicaid
TXC17631Medicare UPIN
TX134062202Medicaid