Jordan, Kenneth Wayne

Jordan, Kenneth Wayne is an individual health care provider with primary practice located at 2100 Erwin Rd , Durham NC 27705-3941. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Jordan, Kenneth Wayne can be contacted via phone (919) 684-8111.

Contact Information

Primary practice address
2100 Erwin Rd Durham NC 27705-3941
Phone: (919) 684-8111
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 33260 North Carolina

Profile Details

NPI number 1184628505
LBN Legal business name Jordan, Kenneth Wayne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2005
Last updated Sep 1st, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184628505 NPPES
North Carolina MEDICAID BJ1675531
North Carolina MEDICAID 8947445

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