Healthcare Provider Details

I. General information

NPI: 1578673067
Provider Name (Legal Business Name): AMY C KORB P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S POTOMAC ST STE 400
AURORA CO
80012-4536
US

IV. Provider business mailing address

1860 IRIS ST
LAKEWOOD CO
80215
US

V. Phone/Fax

Practice location:
  • Phone: 303-695-6060
  • Fax:
Mailing address:
  • Phone: 720-299-4919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number010446
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA05052
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA-2933
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: