Provider Demographics
NPI:1841286853
Name:JORDAN, FRANK EDWIN (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:EDWIN
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:F.
Other - Middle Name:E
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:23 WINDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8835
Mailing Address - Country:US
Mailing Address - Phone:731-664-8126
Mailing Address - Fax:731-660-5119
Practice Address - Street 1:160C W UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1667
Practice Address - Country:US
Practice Address - Phone:731-660-5116
Practice Address - Fax:731-554-0306
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD14614207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3005044Medicaid
TN3005044Medicaid
TN103I057927Medicare PIN
TN3005043Medicare PIN
1840642OtherCIGNA
TN3039369OtherBCBS
TN5244760001Medicare NSC
TN050048967OtherRAILROAD MEDICARE PIN