Provider Demographics
NPI:1962690263
Name:JORDAN, PAUL FRITZ (ACNP)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:FRITZ
Last Name:JORDAN
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18220 STATE HIGHWAY 249
Mailing Address - Street 2:CRITICAL CARE TEAM
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4347
Mailing Address - Country:US
Mailing Address - Phone:281-737-9663
Mailing Address - Fax:281-737-2919
Practice Address - Street 1:18220 STATE HIGHWAY 249
Practice Address - Street 2:CRITICAL CARE TEAM
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:281-737-9663
Practice Address - Fax:281-737-2919
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595381163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1962690263OtherBLUE CROSS BLUE SHIELD
TX167264403Medicaid
TX595381OtherTSMBE
TX167264403Medicaid