Robert Bruce Jordan, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

MD.009180 Issued in LA

Practice address

253 Wilderness Dr
Boyce, LA 71409-8618

Phone

(318) 443-2418

Fax

(318) 443-2410

NPI assigned

Jun 8, 2006

Last updated

Jul 7, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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• Central Louisiana Imaging, Inc.

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• Christus Health Central Louisiana

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• Minimally Invasive Image Guided Specialists, LLC

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• Phoenix Diagnostic Imaging Inc

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• Radadvantage a Professional Corporation

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  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246924800000",
    "number": "1316988900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7146",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713060146",
            "telephone_number": "805-901-0204",
            "fax_number": "318-443-2410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "253 WILDERNESS DR",
            "city": "BOYCE",
            "state": "LA",
            "postal_code": "714098618",
            "telephone_number": "318-443-2418",
            "fax_number": "318-443-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "ROBERT",
        "middle_name": "BRUCE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2009-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "C26156",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "LA",
            "license": "MD.009180",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "J1277",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0106037",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C261560",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Thibaut Djapni, PHARMD
• Anna Lita Dubois, APRN, FNP-C
• Tequitra Gray
• Jiffy Cab, LLC.
• Marcuz Johnson
• Kellie's Sitting Services (Kellie's Vocationa Supports)
• Kellie's Sitting Services, Inc (Kellie's Vocational Supports)
• Kellie's Sitting Services, Inc.
• Kellie's Sitting Services, Inc.
• Kellie's Sitting Services, Inc. (Kellie's Vocational Supports)

• Diagnostic Radiology Physician in Boyce, LA
• Providers in Boyce, LA by specialty
• Diagnostic Radiology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.