Jeremy Todd Jordan, PA-C, MBA
Physician Assistant in Charleston, WV. Individual provider (NPI-1).
NPI number1790729614
StatusActive
Last updated in NPPESAug 3, 2021
Details
- NPI
- 1790729614
- Entity type
- Individual (NPI-1)
- Name
- Mr. Jeremy Todd Jordan
- Credential
- PA-C, MBA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 15, 2006
- Certification date
- Aug 3, 2021
- Last updated
- Aug 3, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 823 | WV | Yes |
Other names
- Todd Jordan (Other Name)
Practice location
3200 Maccorkle Ave SeCharleston, WV 25304-1297
Phone 304-388-5432
Mailing address
2300 Maccorkle Ave SeCharleston, WV 25304-1099
Phone 304-357-4790
Other practice locations
4602 Maccorkle Ave Se
Charleston, WV 25304-1848
Charleston, WV 25304-1848
Phone 304-925-4777 · Fax 304-925-4780
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