Provider Demographics
NPI:1659376655
Name:CORRADO, JOSEPH ALAN (MD, FACS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALAN
Last Name:CORRADO
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-3753
Mailing Address - Country:US
Mailing Address - Phone:573-581-3991
Mailing Address - Fax:573-581-8558
Practice Address - Street 1:809 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3753
Practice Address - Country:US
Practice Address - Phone:573-581-3991
Practice Address - Fax:573-581-8558
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9B83208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201898202Medicaid