Healthcare Provider Details

I. General information

NPI: 1659376655
Provider Name (Legal Business Name): JOSEPH ALAN CORRADO MD, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 MEDICAL PARK DR
MEXICO MO
65265-3753
US

IV. Provider business mailing address

809 MEDICAL PARK DR
MEXICO MO
65265-3753
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-3991
  • Fax: 573-581-8558
Mailing address:
  • Phone: 573-581-3991
  • Fax: 573-581-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR9B83
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: