Healthcare Provider Details

I. General information

NPI: 1790727030
Provider Name (Legal Business Name): BRUCE CLAYTON CORSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5240 E GALBRAITH RD STE A
CINCINNATI OH
45236-2879
US

IV. Provider business mailing address

5240 E GALBRAITH RD STE A
CINCINNATI OH
45236-2879
US

V. Phone/Fax

Practice location:
  • Phone: 513-721-7533
  • Fax: 513-721-1649
Mailing address:
  • Phone: 513-721-7533
  • Fax: 513-721-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35046569
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number35046569
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: