Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01081953A | IN |
Y | 207X00000X | Orthopaedic Surgeon | 26784 | OK |
N | 207X00000X | Orthopaedic Surgeon | M5108 | TX |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | M5108 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | M5108 | TX |
N | 207XX0801X | Orthopaedic Trauma Surgeon | M5108 | TX |
NPI | 1508839812 |
---|---|
Provider Name | Scot Alan Cordray |
First Address | Detroit, MI 48278-1076 |
Second Address | Lawton, OK 73505-6100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104259 | (02) | |
8G8109 | BCBS (01) | TX |
I34625 | (02) |