=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295720985
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTA CARMAN CORN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2005
-----------------------------------------------------
Last Update Date | 02/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 W THOMAS RD SUITE 203
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85013-4417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-246-8666
-----------------------------------------------------
Fax | 602-246-6082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 171 W BOCA RATON RD
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85023-6250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-246-8666
-----------------------------------------------------
Fax | 602-246-6082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 18489
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------