Provider Demographics
NPI:1932337342
Name:JORDAN, ALISTAIR CLIFFORD (DO)
Entity type:Individual
Prefix:DR
First Name:ALISTAIR
Middle Name:CLIFFORD
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 CARIBOU DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4325
Mailing Address - Country:US
Mailing Address - Phone:970-484-4758
Mailing Address - Fax:970-484-4759
Practice Address - Street 1:2008 CARIBOU DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4325
Practice Address - Country:US
Practice Address - Phone:970-484-4758
Practice Address - Fax:970-484-4759
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10153A2085R0204X
CODR.00552322085R0204X
NE13352085R0204X
WYTL30472085R0204X
CODR00552322085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM404327ZM7VOtherMEDICARE PTAN