Provider Demographics
NPI:1750463469
Name:JORDAN, EARL LAWRENCE JR (DO)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:LAWRENCE
Last Name:JORDAN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2630 CUNNINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1542
Mailing Address - Country:US
Mailing Address - Phone:417-781-0044
Mailing Address - Fax:417-781-6331
Practice Address - Street 1:2630 CUNNINGHAM AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1542
Practice Address - Country:US
Practice Address - Phone:417-781-0044
Practice Address - Fax:417-781-6331
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2015-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR7D82207W00000X
KS0521009207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS106030OtherBLUE CROSS/BLUE SHIELD
MO180027096OtherRAILROAD MEDICARE
MO241986504Medicaid
KS100229750BMedicaid
KS100229750CMedicaid
KS180027097OtherRAILROAD MEDICARE
OK100026260AMedicaid
A10396Medicare UPIN
OK100026260AMedicaid
KS106030OtherBLUE CROSS/BLUE SHIELD