Provider Demographics
NPI:1205985082
Name:JORDAN, DONNA RAE (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:RAE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3581 PALMER DR
Mailing Address - Street 2:STE. 401
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8236
Mailing Address - Country:US
Mailing Address - Phone:530-676-4122
Mailing Address - Fax:530-676-6644
Practice Address - Street 1:3581 PALMER DR
Practice Address - Street 2:STE. 401
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8236
Practice Address - Country:US
Practice Address - Phone:530-676-4122
Practice Address - Fax:530-676-6644
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG58700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG58700OtherMEDICAL LICENSE
CABJ1137389OtherDEA