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NPI Code Detail

MEDICARE: MR. JORDAN MICHAEL MAST PA-C

MEDICARE: MR. JORDAN MICHAEL MAST PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA.0003581CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518211051
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JORDAN MICHAEL MAST PA-C
Provider Business Mailing Address
First Line : 950 EAST HARVARD AVE STE 570
Second Line :
City : DENVER
State : CO
Zip : 80210-7003
Country : US
Telephone Number : 303-715-9024
Fax Number :
Provider Business Practice Location Address
First Line : 950 EAST HARVARD AVE STE 570
Second Line :
City : DENVER
State : CO
Zip : 80210-7003
Country : US
Telephone Number : 303-715-9024
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2012
Last Update Date : 03/25/2015

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