Basic Information
| Provider Information | |||||||||
| NPI: | 1770146862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | READER | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | MARK | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 NW SAMARITAN DR | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973303737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417684906 | ||||||||
| FaxNumber: | 5417684907 | ||||||||
| Practice Location | |||||||||
| Address1: | 697 W TEFFT ST | ||||||||
| Address2: | |||||||||
| City: | NIPOMO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934449190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059292272 | ||||||||
| FaxNumber: | 8059291454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2019 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A20095 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.