Provider Demographics
NPI:1396710174
Name:JORDE, DAVID O (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:O
Last Name:JORDE
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 1:1502 LONDON RD
Mailing Address - Street 2:102
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1788
Mailing Address - Country:US
Mailing Address - Phone:218-576-0100
Mailing Address - Fax:
Practice Address - Street 1:1502 LONDON RD
Practice Address - Street 2:102
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1788
Practice Address - Country:US
Practice Address - Phone:218-576-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN963027900Medicaid
MN963027900Medicaid
MN080021206Medicare PIN
MN963027900Medicaid