Provider Demographics
NPI:1306898028
Name:JORDAN, WILLIAM MCCALL (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MCCALL
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:800 W MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4611
Mailing Address - Country:US
Mailing Address - Phone:817-759-7000
Mailing Address - Fax:817-759-7027
Practice Address - Street 1:95 S PAGOSA BLVD
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-8329
Practice Address - Country:US
Practice Address - Phone:970-507-4000
Practice Address - Fax:970-731-1988
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1345207RH0003X, 207RX0202X
CODR.0043185207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1319550-08Medicaid
TX8EF216OtherBCBS
TX1319550-02Medicaid
TX131955009Medicaid
TX131955009Medicaid
TXA67214Medicare UPIN
TX340875YS7YMedicare PIN
TX1319550-02Medicaid
TX1319550-08Medicaid
TXTEZJ23YS7YMedicare PIN