Dr. Jordan Blaine Coulston, M.D
Internal Medicine in Gilbert, AZ. Individual provider (NPI-1).
NPI number1487850004
StatusActive
Last updated in NPPESNov 18, 2010
Details
- NPI
- 1487850004
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jordan Blaine Coulston
- Credential
- M.D
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 21, 2007
- Last updated
- Nov 18, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | 43356 | AZ | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
1900 N Higley RdGilbert, AZ 85234-1604
Phone 480-543-2034 · Fax 480-543-2647
Mailing address
1900 N Higley RdGilbert, AZ 85234-1604
Phone 480-543-2034 · Fax 480-543-2647
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