Provider Demographics
NPI:1558548040
Name:CORDOVA INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:CORDOVA INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:LOFTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-757-1200
Mailing Address - Street 1:8066 WALNUT RUN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8841
Mailing Address - Country:US
Mailing Address - Phone:901-757-1200
Mailing Address - Fax:901-756-7010
Practice Address - Street 1:8066 WALNUT RUN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8841
Practice Address - Country:US
Practice Address - Phone:901-757-1200
Practice Address - Fax:901-756-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0562960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty