Doctor Name: | DR. JORDAN LANE GUICE |
NPI Number: | 1033556543 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 0101257728 |
Business Practice Address: | 3551 Roger Brooke Dr Fort Sam Houston, TX - 782344504 |
Business Phone Number: | 2109160439 |
Business Fax Number: | 2109166658 |
Mailing Address: | 227 Irvington Dr, SAN ANTONIO |
State: | TX |
Postal Code: | 782094219 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/24/2013 |
NPI Last Update Date: | 04/04/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 0101257728 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |