Healthcare Provider Details

I. General information

NPI: 1710009113
Provider Name (Legal Business Name): JEAN F. CORIA, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

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: 817-633-2926
  • Fax: 817-633-1504
Mailing address:
  • Phone: 817-999-5134
  • Fax: 817-633-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number81509803
License Number StateTX

VIII. Authorized Official

Name: DR. JEAN F CORIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 817-999-5134