Provider Demographics
NPI:1710961982
Name:CORDER, FREDERICK ALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ALVIN
Last Name:CORDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FRED OR FREDRICK
Other - Middle Name:ALVIN
Other - Last Name:CORDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-0600
Mailing Address - Country:US
Mailing Address - Phone:662-284-9706
Mailing Address - Fax:662-284-9904
Practice Address - Street 1:3050 CORDER DRIVE
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834
Practice Address - Country:US
Practice Address - Phone:662-284-9902
Practice Address - Fax:662-284-9904
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16746207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122205Medicaid
MS16746OtherSTATE MEDICAL LICENSE
MS16746OtherSTATE MEDICAL LICENSE
MSH16463Medicare UPIN