Provider Demographics
NPI:1730877010
Name:JORDAN, ALEXANDER SCOTT (PA-C)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:SCOTT
Last Name:JORDAN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 122342
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2342
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:2770 3RD AVE STE 120
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8994
Practice Address - Country:US
Practice Address - Phone:337-494-4868
Practice Address - Fax:337-494-4870
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2024-09-19
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Provider Licenses
StateLicense IDTaxonomies
LA335456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant