Provider Demographics
NPI:1992835748
Name:PARDINGTON, BRENDON (PA)
Entity type:Individual
Prefix:
First Name:BRENDON
Middle Name:
Last Name:PARDINGTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8037 E 22ND PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3075
Mailing Address - Country:US
Mailing Address - Phone:720-220-5623
Mailing Address - Fax:
Practice Address - Street 1:12510 E ILIFF AVE STE 120
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6377
Practice Address - Country:US
Practice Address - Phone:303-591-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2165363A00000X
COPA.0002165363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
017254OtherKAISER-COMMERCIAL NUMBER
CO96973234Medicaid
CO96973234Medicaid
COC804691Medicare PIN
017254OtherKAISER-COMMERCIAL NUMBER