MEDICARE: JOHN GREGORY CORCORAN

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	207RI0200X	Infectious Disease Physician	12377	AZ

General Provider Information

NPI Number	:	1194026757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN GREGORY CORCORAN

Provider Business Mailing Address
First Line	:	5265 E KNIGHT DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2147
Country	:	US
Telephone Number	:	520-327-5911
Fax Number	:	520-881-0060

Provider Business Practice Location Address
First Line	:	5265 EAST KNIGHT DRIVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712
Country	:	US
Telephone Number	:	520-327-5911
Fax Number	:	520-881-0060

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN G CORCORAN
Credential	:	M.D.
Telephone Number	:	520-327-5911

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	06/13/2011

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