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General NPI Number Information
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NPI Number | 1508934845
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Entity Type | Organization
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Legal Business Name | KEITH F KORVER MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 3536 MEDOCINO AVENUE SUITE 200
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City | SANTA ROSA
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State | CA
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Zip | 95403
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Country | US
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Telephone | 707-573-6166
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 UNOCAL PL STE 207
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City | SANTA ROSA
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State | CA
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Zip | 95403-0918
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Country | US
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Telephone | 707-569-7860
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Fax | 707-545-5408
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEITH KORVER
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Credential |
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Telephone | 707-569-7860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | G0522350
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License Number State | CA
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