Basic Information
| Provider Information | |||||||||
| NPI: | 1144204595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORDERO | ||||||||
| FirstName: | JOEHASSIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794085865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432898 | ||||||||
| FaxNumber: | 8067432787 | ||||||||
| Practice Location | |||||||||
| Address1: | 3502 9TH ST | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794153300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067434115 | ||||||||
| FaxNumber: | 8067431313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | L6841 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 044802901 | 05 | TX | MEDICAID | 201021532 | 05 | NM | MEDICAID | 100220970A | 05 | OK | MEDICAID | A019 | 01 | NM | TRIWEST | OTHER | 201021532 | 01 | TX | FIRSTCARE COMMERCIAL | OTHER | Z5551 | 05 | NM | MEDICAID | 110806100 | 01 | TX | FIRSTCARE COMMERCIAL | OTHER | 110806101 | 05 | TX | MEDICAID | 83935Z | 01 | TX | HMO BLUE | OTHER | 141303101 | 05 | TX | MEDICAID | 87187G | 01 | TX | BC/BS | OTHER |