Provider Demographics
NPI:1932142445
Name:CORDOVA, JOSEPH D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 OAK HILL CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-9517
Mailing Address - Country:US
Mailing Address - Phone:817-923-1515
Mailing Address - Fax:
Practice Address - Street 1:2450 OAK HILL CIR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-9509
Practice Address - Country:US
Practice Address - Phone:817-923-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185663507Medicaid
TX0019PTOtherBCBS
TX185663501Medicaid
TX185663507Medicaid
TX8L20208Medicare PIN
TXP00442144Medicare UPIN