Provider Demographics
NPI:1457705295
Name:ACHTMAN, JORDAN CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:CHARLES
Last Name:ACHTMAN
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 1:5534 MERRIMAC AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5832
Mailing Address - Country:US
Mailing Address - Phone:214-727-8888
Mailing Address - Fax:
Practice Address - Street 1:4010 W PARK BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3839
Practice Address - Country:US
Practice Address - Phone:972-362-9567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5531207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology