Provider Demographics
NPI:1740273309
Name:JORDAN, RICHARD LIMING (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LIMING
Last Name:JORDAN
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 1:3280A HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5250
Mailing Address - Country:US
Mailing Address - Phone:910-937-7200
Mailing Address - Fax:910-937-7061
Practice Address - Street 1:3280A HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5250
Practice Address - Country:US
Practice Address - Phone:910-937-7200
Practice Address - Fax:910-937-7061
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-29
Last Update Date:2007-07-09
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
NC19612207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC47413OtherBCBS
NC8947413Medicaid
NCC80892Medicare UPIN
NC201785KMedicare ID - Type UnspecifiedMEDICARE