Individual
TIMOTHY PAUL KORDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2620 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3396
(573) 686-4111
Mailing address
PO BOX 88, POPLAR BLUFF, MO 63902-0088
(573) 727-2724
(573) 727-2788
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2004031215
MO
Other
Enumeration date
04/04/2008
Last updated
04/04/2008
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