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General NPI Number Information
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NPI Number | 1497741409
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Entity Type | Individual
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Provider Name | RANDALL COREY OREM D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 02/15/2025
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Provider Practice Location Address
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Address Line | 295 NW PEACOCK BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-2212
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Country | US
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Telephone | 800-991-6117
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Fax |
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Provider Business Mailing Address
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Address Line | 1103 FAIRINGTON DR
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City | SIDNEY
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State | OH
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Zip | 45365-8130
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Country | US
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Telephone | 937-497-1200
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Fax | 937-497-7013
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | OH340038490
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | OS15763
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | OS15763
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License Number State | FL
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