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General NPI Number Information
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NPI Number | 1417695206
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Entity Type | Individual
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Provider Name | CORINNE MARYSSA SPIRES
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Gender | Female
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 117 E MAIN ST STE A100
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City | PAYSON
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State | AZ
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Zip | 85541-4606
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Country | US
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Telephone | 928-596-4500
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Fax | 928-596-4545
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Provider Business Mailing Address
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Address Line | 117 E MAIN ST STE A100
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City | PAYSON
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State | AZ
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Zip | 85541-4606
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Country | US
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Telephone | 928-596-4500
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Fax | 928-596-4545
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 76930
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License Number State | AZ
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