Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 48958 | CO |
Y | 2080P0201X | Pediatric Allergist | DR.0048958 | CO |
NPI | 1235315375 |
---|---|
Provider Name | Dr. Jordan Keith Abbott |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2008 |
Last Update Date | 13/04/2020 |