Healthcare Provider Details

I. General information

NPI: 1356807952
Provider Name (Legal Business Name): JOSEPH LEE CORPREW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 PLANTATION CENTER DR STE 103
RALEIGH NC
27616-5191
US

IV. Provider business mailing address

2600 COLONY WOODS DR
APEX NC
27523-6227
US

V. Phone/Fax

Practice location:
  • Phone: 919-924-6460
  • Fax:
Mailing address:
  • Phone: 919-924-6460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: