Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | E8406 | TX |
NPI | 1013010255 |
---|---|
Provider Name | Dr. Stephen Archie Cord |
First Address | Lubbock, TX 79410-1122 |
Second Address | Lubbock, TX 79410-1122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 25/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
089723301 | (05) | TX |
89101Y | BLUE CROSS (01) | TX |
C14766 | (02) | TX |