MEDICARE: DAVID DICKSON CORLEY JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	H4251	TX
2	207RC0000X	Cardiovascular Disease Physician	H4251	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110188988	OTHER	TX	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	85K259	OTHER	TX	BLLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144217084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DICKSON CORLEY JR. MD

Provider Business Mailing Address
First Line	:	1300 W TERRELL AVE STE 500
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2810
Country	:	US
Telephone Number	:	817-252-5000
Fax Number	:	817-252-5060

Provider Business Practice Location Address
First Line	:	1300 W TERRELL AVE STE 500
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2810
Country	:	US
Telephone Number	:	817-252-5000
Fax Number	:	817-252-5060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	08/18/2022

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Directions to “ DAVID DICKSON CORLEY JR. MD” Practice Location

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