Provider Demographics
NPI:1144204595
Name:CORDERO, JOEHASSIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEHASSIN
Middle Name:
Last Name:CORDERO
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:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3502 9TH ST
Practice Address - Street 2:SUITE 410
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3300
Practice Address - Country:US
Practice Address - Phone:806-743-4115
Practice Address - Fax:806-743-1313
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6841207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044802901Medicaid
NM201021532Medicaid
OK100220970AMedicaid
NMA019OtherTRIWEST
TX201021532OtherFIRSTCARE COMMERCIAL
NMZ5551Medicaid
TX110806100OtherFIRSTCARE COMMERCIAL
TX110806101Medicaid
TX83935ZOtherHMO BLUE
TX141303101Medicaid
TX87187GOtherBC/BS