Provider Demographics
NPI:1356196083
Name:HOWARD, JORDAN MATTHEW
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:MATTHEW
Last Name:HOWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 WINTHROP DR APT 5308
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1860
Mailing Address - Country:US
Mailing Address - Phone:859-582-0594
Mailing Address - Fax:
Practice Address - Street 1:1120 WEST MICHIGAN STREET, GATCH HALL 630
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-278-2689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program