Individual
JOHN CODD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
126 SOUTHARM DR, SAINT LOUIS, MO 63122-4658
(314) 822-1938
(314) 698-2838
Mailing address
126 SOUTHARM DR, SAINT LOUIS, MO 63122-4658
(314) 822-1938
(314) 698-2838
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
036052808
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0283463021
—
IL
01
—
04132028
BCBS
IL
01
—
207988
GROUP MEDICARE
IL
01
—
CG2264
RR GROUP NUMBER
IL
01
—
P00299003
RAILROAD MEDICARE
IL
Enumeration date
06/04/2006
Last updated
12/04/2013
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