Provider Demographics
NPI:1902848971
Name:CORDY, ROY ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:ALEXANDER
Last Name:CORDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:914 3RD AVE S
Mailing Address - Street 2:APT #3
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1784
Mailing Address - Country:US
Mailing Address - Phone:701-235-3390
Mailing Address - Fax:
Practice Address - Street 1:600 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1431
Practice Address - Country:US
Practice Address - Phone:218-732-3311
Practice Address - Fax:218-732-1368
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33744207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNE57371Medicare UPIN