DR. JORDAN LEE WALLIN (NPI# 1811177652) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811177652 |
| Entity Type | Individual |
| Full Name | DR. JORDAN LEE WALLIN |
| Credential | M.D. |
| Practice Address |
446 S Mall Dr Ste B1 St George UT 84790-4945 |
| Practice Telephone | 4356278150 |
| Practice Fax Number | 4355804028 |
| Mailing Telephone | 4356278150 |
| Mailing Fax Number | 4355804028 |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2019-10-23 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Y00000X | Otolaryngology | 2008-01743 | NC | Allopathic & Osteopathic Physicians |
| Y | 207YS0123X |
Otolaryngology Specialization: Facial Plastic Surgery |
2008-01743 | NC | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| Department of Otolaryngology Watlington Hl, Medical Center Blvd, Winston Salem, NC 271570001 | 3367163648 |
| Street Address |
446 S MALL DR STE B1 |
| City | ST GEORGE |
| State | UT |
| Zip Code | 84790-4945 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396342713 | Katrina Poulsen | Student in an Organized Health Care Education/Training Program | 617 East Rriverside Dr, Ste 301, St. George, UT 84790 | 2020-10-08 |
| 1124643226 | Desert View Eyecare | Optometrist | 15 South River Road St. 150, St. George, UT 84790 | 2020-06-15 |
| 1366066417 | Benjamin Todd Lloyd | Dentist | 1683 E. Wolf Hole Dr, St. George, UT 84790 | 2020-06-04 |
| 1801434584 | Jennifer M Putnam | Marriage & Family Therapist | 321 North Mall Drive, Vw103, St. George, UT 84790 | 2019-12-12 |
| 1326683012 | Red Mountain Counseling and Education | Counselor | 321 No Mall Dr, Vw 103, St. George, UT 84790 | 2019-11-17 |
| 1295376002 | Karynne Kimberly Simpson | Behavior Technician | 280 N 1680 E U1, St. George, UT 84790 | 2019-10-02 |
| 1962053017 | Mikala Larsen | Nurse Practitioner | 1380 S Medical Center Dr., Saint George, UT 84790 | 2019-09-20 |
| 1326690678 | Joe Ballent | Student in an Organized Health Care Education/Training Program | 1526 S Medical Center Dr Ste 224a, St George, UT 84790 | 2019-07-16 |
| 1558923854 | David Pace | Optometrist | 749 South River Rd, St. George, UT 84790 | 2019-07-08 |
| 1639734924 | Mariah Ann Mertlich | Behavioral Analyst | 280 N 1680 E, U1, St. George, UT 84790 | 2019-05-02 |
| Find all providers in zip 84790 | ||||
| Taxonomy Code | 207YS0123X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Facial Plastic Surgery |
| An otolaryngologist who specializes in facial plastic surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate was, but is no longer issued by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881702355 | Kent Eric Gardner | Otolaryngology | 1490 E Foremaster Dr, Suite 350, St George, UT 84790-4488 | 2006-08-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467751008 | Amir Allak | Otolaryngology | 3584 W 9000 S Ste 311, West Jordan, UT 84088-4775 | 2011-03-22 |
| 1932367976 | Lucy Barr Md PC Dba Barr Aesthetics | Otolaryngology | 24 South 1100 East Ste 102, Salt Lake City, UT 84102 | 2008-05-27 |
| 1487198321 | Utah Plastic Surgery LLC | Otolaryngology | 2255 N 1700 W, #205, Layton, UT 84041-1119 | 2016-12-12 |
| 1114378023 | Ward Md LLC | Otolaryngology | 6322 S 3000 E, Suite 170, Salt Lake City, UT 84121-6922 | 2016-06-22 |
| 1194119685 | University of Utah Dental Services | Otolaryngology | 50 N Medical Dr, Salt Lake City, UT 84132-0100 | 2015-03-24 |
| 1093024689 | Utah Head and Neck Surgery | Otolaryngology | 945 W Hospital Dr Ste 1, Price, UT 84501-4230 | 2010-09-29 |
| 1932307188 | Lucy Jane Barr | Otolaryngology | 82 S 1100 E, Suite 200, Salt Lake City, UT 84102-1686 | 2007-07-10 |
| 1265522874 | Steven Ross Mobley | Otolaryngology | 5292 S College Dr, Suite 303, Murray, UT 84123-2958 | 2006-10-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.