Provider Demographics
NPI:1174769301
Name:HARTHOORN, CORDELL EVAN (MD)
Entity type:Individual
Prefix:DR
First Name:CORDELL
Middle Name:EVAN
Last Name:HARTHOORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:COREY
Other - Middle Name:EVAN
Other - Last Name:HARTHOORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233 N 48TH ST STE K
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-3512
Practice Address - Country:US
Practice Address - Phone:402-831-3652
Practice Address - Fax:877-550-2086
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-41727207Q00000X
IL036147964207Q00000X
SD11396207Q00000X
COCDR.0000260207Q00000X
UT11090546-1205207Q00000X
WAMD60921102207Q00000X
NE21459207Q00000X
AZ57802207Q00000X
IAMD-45813207Q00000X
MN64844207Q00000X
MEMD22777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine