Healthcare Provider Details

I. General information

NPI: 1770508327
Provider Name (Legal Business Name): ROBERT L CORDER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 EDMOND ST STE 203
SAINT JOSEPH MO
64501-2762
US

IV. Provider business mailing address

902 EDMOND ST STE 203
SAINT JOSEPH MO
64501-2762
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-4300
  • Fax:
Mailing address:
  • Phone: 816-364-4300
  • Fax: 816-279-8148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR6429
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberR6429
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: