Provider Demographics
NPI:1801281779
Name:ERNST, JORDAN (DPM, MS)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:ERNST
Suffix:
Gender:M
Credentials:DPM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 STARS AND STRIPES WAY APT 471
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-1520
Mailing Address - Country:US
Mailing Address - Phone:402-881-1522
Mailing Address - Fax:
Practice Address - Street 1:1600 W COLLEGE ST STE 100
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3575
Practice Address - Country:US
Practice Address - Phone:817-421-0505
Practice Address - Fax:817-421-6060
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3012213ES0103X
390200000X
FLPO3988213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program