Provider Demographics
NPI:1780007732
Name:SPIRA, JORDAN M (PA-C)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:M
Last Name:SPIRA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:M
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-861-2663
Mailing Address - Fax:303-861-4741
Practice Address - Street 1:2055 N HIGH ST
Practice Address - Street 2:#130
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5503
Practice Address - Country:US
Practice Address - Phone:303-861-2663
Practice Address - Fax:303-861-4741
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25857339Medicaid