Derrick Lamont Jordan

NPI 1194039099 - Student in an Organized Health Care Education/Training Program - 390200000X

NPI Details
NPI 1194039099
Gender Male
Enumeration Date 08/03/2010
Last Updated 08/03/2010
Entity Type Individual
Active Over 6 years ago
Practice Location
1850 PINEVIEW DR
COLUMBIA SC, 29209-5085, US
Phone (803) 783-0303
Fax
Business Location
1001 TRUE ST
APARTMENT 101
COLUMBIA SC, 29209-1746, US
Phone (803) 840-7258
Fax
Toxanomy
Taxonomy Code 390200000X
License State
License Number
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According to our database, Derrick Lamont Jordan NPI is 1194039099, taxonomy code is 390200000X Derrick Lamont Jordan physically located at 1850 Pineview Dr, Columbia SC, 29209-5085. NPI Number Derrick Lamont Jordan has the Individual type.

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1194039099 NPI number is provided on an as is basis without warranty of any kind. 1194039099 is maintained by the National Plan & Provider Enumeration System. The contents of Derrick Lamont Jordan are for informational purposes only.