Provider Demographics
NPI:1265400634
Name:PASTOREK, JORDAN (MD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:PASTOREK
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 1:4645 AVON LN
Mailing Address - Street 2:STE 200
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1559
Mailing Address - Country:US
Mailing Address - Phone:469-430-5850
Mailing Address - Fax:877-722-7085
Practice Address - Street 1:4645 AVON LN
Practice Address - Street 2:STE 200
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1559
Practice Address - Country:US
Practice Address - Phone:469-430-5850
Practice Address - Fax:877-722-7085
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19850207R00000X
TXM1286207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03081311Medicaid
MS64-6000515OtherTAX ID
TX278820YPHFMedicare PIN
TX278820YKPWMedicare PIN
TX278820YKQLMedicare PIN
MS64-6000515OtherTAX ID
MS03081311Medicaid
TX278820YKP5Medicare PIN