Basic Information
| Provider Information | |||||||||
| NPI: | 1982681383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JORDING | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 FAIRMONT BLVD | ||||||||
| Address2: | ATTEN CHRISTIE MSS | ||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577017350 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1121 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | NEWCASTLE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077463582 | ||||||||
| FaxNumber: | 3077469744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2005 | ||||||||
| LastUpdateDate: | 12/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3427A | WY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.