Provider Demographics
NPI:1326045642
Name:JORDAN, ARTHUR E (MD)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:E
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641-0484
Mailing Address - Country:US
Mailing Address - Phone:864-546-4497
Mailing Address - Fax:864-546-4506
Practice Address - Street 1:1005 GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4630
Practice Address - Country:US
Practice Address - Phone:864-404-3094
Practice Address - Fax:864-242-6517
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8003208VP0014X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC05186089OtherMEDICARE PTAN
NC89016NGMedicaid
SCP00326713OtherRR MEDICARE
SCGP3980Medicaid
SC187649OtherMEDCOST
SC606006100OtherDEPT. OF LABOR
SC201138864OtherBCBS OF SC
SCDB9785OtherRR MEDICARE
SC080030Medicaid
NC7905930Medicaid
NC89016NGMedicaid
SCDB9785OtherRR MEDICARE
SC080030Medicaid
SC$$$$$$$$$OtherBCBS OF SC
SC201138864OtherBCBS OF SC
SC606006100OtherDEPT. OF LABOR