Healthcare Provider Details

I. General information

NPI: 1881979391
Provider Name (Legal Business Name): DANIEL M CORCORAN DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2011
Last Update Date: 08/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 N CENTER ST SUITE 101
MESA AZ
85201-5084
US

IV. Provider business mailing address

744 N CENTER ST SUITE 101
MESA AZ
85201-5084
US

V. Phone/Fax

Practice location:
  • Phone: 480-275-7017
  • Fax:
Mailing address:
  • Phone: 480-275-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVT 60014477
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number6824
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number6239
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: