Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 61160 | WI |
N | 208200000X | Surgeon | 61160 | WI |
N | 208600000X | Surgeon | 61160 | WI |
NPI | 1073510731 |
---|---|
Provider Name | John F Cordova |
First Address | Marshfield, WI 54449-5703 |
Second Address | Marshfield, WI 54449-5703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 26/08/2013 |