Provider Demographics
NPI:1225288624
Name:MUELL, JORDAN (PA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:MUELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 S WADSWORTH BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3111
Mailing Address - Country:US
Mailing Address - Phone:303-202-1280
Mailing Address - Fax:303-202-1281
Practice Address - Street 1:2551 W. 84TH AVE.
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030
Practice Address - Country:US
Practice Address - Phone:303-426-2020
Practice Address - Fax:303-426-2164
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO2610363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13922742Medicaid
COP00806240OtherRR MEDICARE
COP00806240OtherRR MEDICARE