Provider Demographics
NPI:1215913082
Name:CORDOVER, ALAN J (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:J
Last Name:CORDOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 551420
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1420
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:855-851-4405
Practice Address - Street 1:4725 N. FEDERAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-771-8000
Practice Address - Fax:954-776-3270
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME75893207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050077235OtherRAILROAD MEDICARE
FL260526100Medicaid
FL58636OtherBLUE CROSS BLUE SHIELD
FL58636ZMedicare PIN
FLG79577Medicare UPIN
G79577Medicare UPIN