Healthcare Provider Details

I. General information

NPI: 1205982576
Provider Name (Legal Business Name): ABNER CORDERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 S MONROE ST
TIFFIN OH
44883-2820
US

IV. Provider business mailing address

143 S MONROE ST
TIFFIN OH
44883-2820
US

V. Phone/Fax

Practice location:
  • Phone: 419-443-0031
  • Fax: 419-443-0131
Mailing address:
  • Phone: 419-443-0031
  • Fax: 419-443-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number66706
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: