Provider Demographics
NPI:1104913656
Name:JORDAN, FRANK THOMAS (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:THOMAS
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7200 W CATHEDRAL ROCK DR
Mailing Address - Street 2:STE #130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-228-8600
Mailing Address - Fax:702-228-8689
Practice Address - Street 1:7200 W CATHEDRAL ROCK DR
Practice Address - Street 2:STE #130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-228-8600
Practice Address - Fax:702-228-8689
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV56872086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002576Medicaid
NV36352Medicare PIN
NVV36352Medicare PIN
NV002002576Medicaid