Provider Demographics
NPI:1013010255
Name:CORD, STEPHEN ARCHIE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ARCHIE
Last Name:CORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1122
Mailing Address - Country:US
Mailing Address - Phone:806-792-4329
Mailing Address - Fax:806-792-9466
Practice Address - Street 1:4110 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1122
Practice Address - Country:US
Practice Address - Phone:806-792-4329
Practice Address - Fax:806-792-9466
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8406207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089723301Medicaid
TX89101YOtherBLUE CROSS
TX8K9421Medicare Oscar/Certification
TX00JY32Medicare ID - Type Unspecified
TX89101YOtherBLUE CROSS
TXC14766Medicare UPIN
TX8K9412Medicare PIN