Basic Information
| Provider Information | |||||||||
| NPI: | 1720188493 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | LAUREL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 N MONTE VISTA ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748204675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804367101 | ||||||||
| FaxNumber: | 5804364447 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 ARLINGTON | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748202822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804369037 | ||||||||
| FaxNumber: | 5804369028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2006 | ||||||||
| LastUpdateDate: | 10/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 34008645 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.