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General NPI Number Information
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NPI Number | 1104259548
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Entity Type | Individual
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Provider Name | BRADLEY THOMAS CORBIN
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Gender | Male
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 1825 KINGSLEY AVE STE 390
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City | ORANGE PARK
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State | FL
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Zip | 32073-4484
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Country | US
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Telephone | 904-639-2260
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Fax | 904-272-1986
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Provider Business Mailing Address
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Address Line | 1825 KINGSLEY AVE STE 390
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City | ORANGE PARK
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State | FL
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Zip | 32073-4484
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Country | US
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Telephone | 904-639-2260
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Fax | 904-272-1986
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME158618
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 5171975
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License Number State | ID
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