Provider Demographics
NPI:1386603744
Name:JORDAN, HEIDI ANN (MD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:ANN
Last Name:JORDAN
Suffix:
Gender:F
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:1631 LANCASTER
Practice Address - Street 2:SUITE 150
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:817-251-9080
Practice Address - Fax:817-251-9082
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3595207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166358505Medicaid
TX166358503Medicaid
TX900126202OtherRAILROAD MEDICARE
TX8L19239Medicare PIN
TX8K5162Medicare PIN
H51628Medicare UPIN