Healthcare Provider Details

I. General information

NPI: 1992760169
Provider Name (Legal Business Name): ERIC STEVEN KORSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 CONVOY ST SUITE 114
SAN DIEGO CA
92111-3742
US

IV. Provider business mailing address

3760 CONVOY ST SUITE 114
SAN DIEGO CA
92111-3742
US

V. Phone/Fax

Practice location:
  • Phone: 858-715-8444
  • Fax: 858-715-8324
Mailing address:
  • Phone: 858-715-8444
  • Fax: 858-715-8324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG84012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: