MEDICARE: DR. JEAN F CORIA M.D.

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	2083X0100X	Occupational Medicine Physician	G6492	TX
2	208D00000X	General Practice Physician	G6492	TX

General Provider Information

NPI Number	:	1558483958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN F CORIA M.D.

Provider Business Mailing Address
First Line	:	2300 CASTLE ROCK RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-2712
Country	:	US
Telephone Number	:	817-999-5134
Fax Number	:	817-633-1504

Provider Business Practice Location Address
First Line	:	2300 CASTLE ROCK RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-2712
Country	:	US
Telephone Number	:	817-999-5134
Fax Number	:	817-633-1504

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	09/06/2011

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