Individual
EDGAR R CORDIVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
516 EAST NIZHONI BLVD., GALLUP, NM 87301-1337
(505) 722-1000
(505) 722-1192
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
16830
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182767
—
AZ
Enumeration date
04/19/2006
Last updated
04/09/2014
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