Provider Demographics
NPI:1740869601
Name:DEHLI, JORDAN ALEXANDER (DO)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALEXANDER
Last Name:DEHLI
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:3401 W MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3704
Practice Address - Country:US
Practice Address - Phone:757-827-1940
Practice Address - Fax:757-896-4715
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2025-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0102208317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine