Provider Demographics
NPI:1619942216
Name:ESPLIN, CORDELL A (MD09)
Entity Type:Individual
Prefix:DR
First Name:CORDELL
Middle Name:A
Last Name:ESPLIN
Suffix:
Gender:M
Credentials:MD09
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 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:1800 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3742
Practice Address - Country:US
Practice Address - Phone:602-254-2123
Practice Address - Fax:602-254-4172
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ153332085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z7077OtherHEALTH NET OF AZ
AZ265373Medicaid
AZAZ0854390OtherBCBSAZ
AZ265373Medicaid
AZ1Z7077OtherHEALTH NET OF AZ
AZAZ0854390OtherBCBSAZ
AZ940000218Medicare PIN