Provider Demographics
NPI:1760585632
Name:ELIZABETH CORDES, D.O., P.C.
Entity Type:Organization
Organization Name:ELIZABETH CORDES, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-285-8285
Mailing Address - Street 1:1616 E 19TH ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6627
Mailing Address - Country:US
Mailing Address - Phone:405-285-8285
Mailing Address - Fax:405-285-8227
Practice Address - Street 1:1616 E 19TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6627
Practice Address - Country:US
Practice Address - Phone:405-285-8285
Practice Address - Fax:405-285-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243529900Medicare ID - Type Unspecified
OKHO7478Medicare UPIN