Healthcare Provider Details

I. General information

NPI: 1558483958
Provider Name (Legal Business Name): JEAN F CORIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 CASTLE ROCK RD
ARLINGTON TX
76006-2712
US

IV. Provider business mailing address

2300 CASTLE ROCK RD
ARLINGTON TX
76006-2712
US

V. Phone/Fax

Practice location:
  • Phone: 817-999-5134
  • Fax: 817-633-1504
Mailing address:
  • Phone: 817-999-5134
  • Fax: 817-633-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberG6492
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG6492
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: