Individual
DR. FOSTER CLINT KORDISCH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1214 COOLIDGE BLVD, LAFAYETTE, LA 70503-2621
(337) 289-7183
Mailing address
142 ACACIA DR, LAFAYETTE, LA 70508-4002
(337) 264-1303
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
24286
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1570044
—
LA
Enumeration date
11/09/2006
Last updated
11/28/2012
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