Healthcare Provider Details

I. General information

NPI: 1679266118
Provider Name (Legal Business Name): CODEE CLARK SPIERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13402 W COAL MINE AVE STE 110
LITTLETON CO
80127-5408
US

IV. Provider business mailing address

6556 EMERALD DUNES DR APT 208
ROYAL PALM BEACH FL
33411-2752
US

V. Phone/Fax

Practice location:
  • Phone: 303-248-7894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberPA9117321
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0008902
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: