{
"Npi": {
"NPI": "1710961982",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CORDER",
"FirstName": "FREDERICK",
"MiddleName": "ALVIN",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CORDER",
"OtherFirstName": "FRED OR FREDRICK",
"OtherMiddleName": "ALVIN",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "PO BOX 600",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORINTH",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "38835-0600",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-284-9706",
"MailingAddressFaxNumber": "662-284-9904",
"FirstLinePracticeLocationAddress": "3050 CORDER DRIVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CORINTH",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "38834",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "662-284-9902",
"PracticeLocationAddressFaxNumber": "662-284-9904",
"EnumerationDate": "12/01/2005",
"LastUpdateDate": "07/09/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RG0100X",
"TaxonomyName": "Gastroenterology Physician",
"LicenseNumber": "16746",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}