Provider Demographics
NPI:1174518526
Name:CORDER, STEPHAN SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:SCOTT
Last Name:CORDER
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 1:619 N BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-9794
Mailing Address - Country:US
Mailing Address - Phone:785-242-7773
Mailing Address - Fax:
Practice Address - Street 1:214 E LOGAN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-2013
Practice Address - Country:US
Practice Address - Phone:785-242-7773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0418093208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100131720AMedicaid
KS617930OtherFIRST GUARD
KS100131720AMedicaid
029900Medicare ID - Type Unspecified