Basic Information
| Provider Information | |||||||||
| NPI: | 1376997957 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | JAXON | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1233 N 18TH ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796012932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3254373687 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1233 N 18TH ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796012932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3254373687 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2016 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | T-3139 | MS | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | S9534 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.