Provider Demographics
NPI:1881140838
Name:JORDAN, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75021-0332
Mailing Address - Country:US
Mailing Address - Phone:903-893-6222
Mailing Address - Fax:
Practice Address - Street 1:101 E JONES ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-7120
Practice Address - Country:US
Practice Address - Phone:903-893-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXME3601225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX768683OtherCOSMETOLOGY ESTABLISHMENT
TXME3601OtherMASSAGE THERAPY ESTABLISHMENT