Healthcare Provider Details

I. General information

NPI: 1245404656
Provider Name (Legal Business Name): CASEY JASPER CORDTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PARK ST
BOWLING GREEN KY
42101-1760
US

IV. Provider business mailing address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

V. Phone/Fax

Practice location:
  • Phone: 270-796-5498
  • Fax: 270-796-5490
Mailing address:
  • Phone: 314-251-6299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2021048792
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35240
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number59959
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: