Provider Demographics
NPI:1336973809
Name:JORDAN, RICKY II
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:JORDAN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 BYRD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2303
Mailing Address - Country:US
Mailing Address - Phone:513-903-8270
Mailing Address - Fax:
Practice Address - Street 1:9888 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-3104
Practice Address - Country:US
Practice Address - Phone:513-903-8270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor