Provider Demographics
NPI:1649384702
Name:STEVAN CORDAS DO, PA
Entity Type:Organization
Organization Name:STEVAN CORDAS DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO MPH
Authorized Official - Phone:817-268-1757
Mailing Address - Street 1:1237 SOUTHRIDGE CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4393
Mailing Address - Country:US
Mailing Address - Phone:817-268-1757
Mailing Address - Fax:817-268-1766
Practice Address - Street 1:1237 SOUTHRIDGE CT
Practice Address - Street 2:SUITE 102
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4393
Practice Address - Country:US
Practice Address - Phone:817-268-1757
Practice Address - Fax:817-268-1766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD53682083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD97294Medicare UPIN
TX00J053Medicare PIN