Provider Demographics
NPI:1619075405
Name:CORDON, YOLANDA (MD)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:CORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 EICHENFIELD DRIVE
Mailing Address - Street 2:STE 101
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5994
Mailing Address - Country:US
Mailing Address - Phone:813-685-7716
Mailing Address - Fax:813-689-4913
Practice Address - Street 1:501 EICHENFELD DR
Practice Address - Street 2:STE 101
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5994
Practice Address - Country:US
Practice Address - Phone:813-685-7716
Practice Address - Fax:813-689-4913
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036502500Medicaid
FL30090Medicare PIN
FL036502500Medicaid