Provider Demographics
NPI:1770508327
Name:CORDER, ROBERT L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:CORDER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:902 EDMOND ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-2762
Mailing Address - Country:US
Mailing Address - Phone:816-364-4300
Mailing Address - Fax:816-279-8148
Practice Address - Street 1:902 EDMOND ST STE 203
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-2762
Practice Address - Country:US
Practice Address - Phone:816-364-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6429207V00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
44054528964506V014OtherTRICARE/CHAMPUS
4570847OtherAETNA
MO465446OtherCHILDRENS MERCY FAMILY HEALTH
MO200946119Medicaid
P00036215OtherRAILROAD MEDICARE
206202OtherHEALTHLINK
KS100002320BMedicaid
602260OtherFIRSTGUARD
MO04119010OtherBLUE CROSS BLUE SHIELD
10001223901OtherCOMMUNITY HEALTH PLAN
206202OtherHEALTHLINK
MO200946119Medicaid