Provider Demographics
NPI:1134236557
Name:CORDRAY, MONTE L (MD)
Entity type:Individual
Prefix:
First Name:MONTE
Middle Name:L
Last Name:CORDRAY
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3130
Mailing Address - Fax:812-242-3596
Practice Address - Street 1:1429 NO 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1037
Practice Address - Country:US
Practice Address - Phone:812-242-3130
Practice Address - Fax:812-242-3596
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034844A208800000X
IL36065200208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100251610Medicaid
340009237OtherRAILROAD MCARE PALAMETTO
340009239OtherRAILROAD MEDICARE
000000089622OtherANTHEM
340009241OtherRAILROAD MCARE PALAMETTO
340009771OtherRAILROAD MCARE PALAMETTO
INP00828498OtherRAILROAD MEDICARE
340009237OtherRAILROAD MCARE PALAMETTO
000000089622OtherANTHEM
INP00828498OtherRAILROAD MEDICARE
C25919Medicare UPIN
IN192770TMedicare PIN
ILL37132Medicare PIN
340009771OtherRAILROAD MCARE PALAMETTO
ILL52064Medicare PIN
IN859910GMedicare PIN