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General NPI Number Information
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NPI Number | 1245404656
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Entity Type | Individual
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Provider Name | CASEY JASPER CORDTS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 250 PARK ST
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City | BOWLING GREEN
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State | KY
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Zip | 42101-1760
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Country | US
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Telephone | 270-796-5498
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Fax | 270-796-5490
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Provider Business Mailing Address
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Address Line | 615 S NEW BALLAS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8221
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Country | US
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Telephone | 314-251-6299
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2021048792
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 35240
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 59959
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License Number State | KY
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