Provider Demographics
NPI:1255999470
Name:CORDOBA MORALES, JOSE DANIEL (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:DANIEL
Last Name:CORDOBA MORALES
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:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-9500
Mailing Address - Fax:515-643-9525
Practice Address - Street 1:4005 NW URBANDALE DR
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-7914
Practice Address - Country:US
Practice Address - Phone:515-643-9500
Practice Address - Fax:515-643-9525
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2024-06-07
Deactivation Date:2020-01-17
Deactivation Code:
Reactivation Date:2022-02-18
Provider Licenses
StateLicense IDTaxonomies
390200000X
IAMD-50245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program