Provider Demographics
NPI:1902054760
Name:MULDER, JORDAN JUSTIN TJEERD (DO)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:JUSTIN TJEERD
Last Name:MULDER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:404B BLACK HILLS LANE SW
Mailing Address - Street 2:CAPITAL ENT
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8654
Mailing Address - Country:US
Mailing Address - Phone:360-704-4745
Mailing Address - Fax:360-704-4746
Practice Address - Street 1:3920 CAPITAL MALL DR SW STE 100A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8701
Practice Address - Country:US
Practice Address - Phone:360-704-4745
Practice Address - Fax:360-704-4746
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP60262509207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery