Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | R6429 | MO |
N | 207V00000X | Obstetrician & Gynecologist | R6429 | MO |
NPI | 1770508327 |
---|---|
Provider Name | Dr. Robert L Corder JR. |
First Address | Saint Joseph, MO 64501-2762 |
Second Address | Saint Joseph, MO 64501-2762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 26/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04119010 | BLUE CROSS BLUE SHIELD (01) | MO |
100002320B | (05) | KS |
10001223901 | COMMUNITY HEALTH PLAN (01) | |
200946119 | (05) | MO |
206202 | HEALTHLINK (01) | |
44054528964506V014 | TRICARE/CHAMPUS (01) | |
4570847 | AETNA (01) | |
465446 | CHILDRENS MERCY FAMILY HEALTH (01) | MO |
602260 | FIRSTGUARD (01) | |
P00036215 | RAILROAD MEDICARE (01) |