Provider Demographics
NPI:1205305026
Name:WILBERT C JORDAN MD INC
Entity type:Organization
Organization Name:WILBERT C JORDAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILBERT
Authorized Official - Middle Name:CORNELIOUS
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-630-1415
Mailing Address - Street 1:16660 PARAMOUNT BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5459
Mailing Address - Country:US
Mailing Address - Phone:562-630-1415
Mailing Address - Fax:562-630-1473
Practice Address - Street 1:16660 PARAMOUNT BLVD STE 303
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5459
Practice Address - Country:US
Practice Address - Phone:562-630-1415
Practice Address - Fax:562-630-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty