Healthcare Provider Details

I. General information

NPI: 1265612329
Provider Name (Legal Business Name): KATHLEEN K CORDES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 10TH AVE STE 250
EUGENE OR
97401-3362
US

IV. Provider business mailing address

401 E 10TH AVE
EUGENE OR
97401-3317
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-4153
  • Fax: 541-686-3468
Mailing address:
  • Phone: 541-686-4153
  • Fax: 541-686-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16009
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier072173
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: