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General NPI Number Information
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NPI Number | 1225193105
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Entity Type | Individual
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Provider Name | JEAN-RONEL CORBIER MD
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 1040 EDGEWATER CORP PKWY SUITE 106
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City | INDIAN LAND
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State | SC
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Zip | 29707-4514
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Country | US
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Telephone | 704-541-9117
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Fax | 704-541-9137
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Provider Business Mailing Address
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Address Line | 1040 EDGEWATER CORP PKWY SUITE 106
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City | INDIAN LAND
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State | SC
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Zip | 29707-4514
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Country | US
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Telephone | 704-541-9117
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Fax | 704-541-9137
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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 | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number | 2006-01910
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 200601910
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License Number State | NC
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