Provider Demographics
NPI:1568959724
Name:POWELL, JORDAN HUGHES (MD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:HUGHES
Last Name:POWELL
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 1:9006 PLEASANT HILL DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-4146
Mailing Address - Country:US
Mailing Address - Phone:817-559-0437
Mailing Address - Fax:
Practice Address - Street 1:OSPEDALE MARINA USA
Practice Address - Street 2:VIA CONTRADA BOSCARIELLO
Practice Address - City:GRICIGNANO DI AVERSA
Practice Address - State:CASERTA
Practice Address - Zip Code:81030
Practice Address - Country:IT
Practice Address - Phone:139-081-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01082754A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine