Provider Demographics
NPI:1184698987
Name:CORDER, J COLLINS (MD)
Entity type:Individual
Prefix:MR
First Name:J
Middle Name:COLLINS
Last Name:CORDER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-996-4545
Mailing Address - Fax:314-996-4546
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:383C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-996-4545
Practice Address - Fax:314-996-4546
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2016-01-19
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Provider Licenses
StateLicense IDTaxonomies
MOR9435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200951028Medicaid
MO014744175Medicare PIN
MOA09935Medicare UPIN