=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083890602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEORGE CORRENT PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2008
-----------------------------------------------------
Last Update Date | 11/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11091 PHOENIX WAY
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34119-8952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-566-9209
-----------------------------------------------------
Fax | 239-566-9209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11091 PHOENIX WAY
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34119-8952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-566-9209
-----------------------------------------------------
Fax | 239-566-9209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. GEORGE F CORRENT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 239-370-1011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | ME50295
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------