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General NPI Number Information
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NPI Number | 1114185758
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Entity Type | Individual
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Provider Name | MICHAEL JEROME CORLEY MD
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Gender | Male
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 645 E MISSOURI AVE STE 300
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City | PHOENIX
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State | AZ
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Zip | 85012-1351
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Country | US
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Telephone | 602-262-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 412 OLIVE AVE # 564
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-5142
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Country | US
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Telephone | 714-536-6715
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Fax | 714-536-6795
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A104108
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 47786
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License Number State | AZ
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