Provider Demographics
NPI:1194921452
Name:JORDAN, CARL DANIEL (DO)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:DANIEL
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:C
Other - Middle Name:DANIEL
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:101 CROWN POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-1191
Mailing Address - Country:US
Mailing Address - Phone:817-757-1675
Mailing Address - Fax:817-757-1676
Practice Address - Street 1:101 CROWN POINTE BLVD
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-1191
Practice Address - Country:US
Practice Address - Phone:817-757-1675
Practice Address - Fax:817-757-1676
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1774208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery