Provider Demographics
NPI:1841288958
Name:CORDERO, EDWIN A (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:A
Last Name:CORDERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:786-293-3200
Mailing Address - Fax:786-293-8819
Practice Address - Street 1:15077 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7930
Practice Address - Country:US
Practice Address - Phone:786-293-3200
Practice Address - Fax:786-293-8819
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065422100Medicaid