Basic Information
| Provider Information | |||||||||
| NPI: | 1932337342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | ALISTAIR | ||||||||
| MiddleName: | CLIFFORD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2008 CARIBOU DR | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805254325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704844758 | ||||||||
| FaxNumber: | 9704844759 | ||||||||
| Practice Location | |||||||||
| Address1: | 2008 CARIBOU DR | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805254325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704844758 | ||||||||
| FaxNumber: | 9704844759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2009 | ||||||||
| LastUpdateDate: | 03/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 10153A | WY | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0204X | DR.0055232 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0204X | 1335 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.