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General NPI Number Information
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NPI Number | 1164586400
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Entity Type | Individual
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Provider Name | FRED CORDER JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 440 BROWNS LN
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City | COSHOCTON
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State | OH
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Zip | 43812-2044
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Country | US
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Telephone | 740-622-0332
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Fax |
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Provider Business Mailing Address
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Address Line | 946 SEVERN DR
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City | COSHOCTON
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State | OH
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Zip | 43812-2737
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Country | US
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Telephone | 740-622-4916
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.000341
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License Number State | OH
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