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General NPI Number Information
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NPI Number | 1538491204
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Entity Type | Organization
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Legal Business Name | CURTIS JOHN CORGAN LLC
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Dates
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Enumeration Date | 02/05/2010
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Last Update Date | 02/05/2010
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Provider Practice Location Address
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Address Line | 12300 SW 69TH PL
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City | PINECREST
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State | FL
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Zip | 33156-5436
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Country | US
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Telephone | 954-258-3899
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Fax |
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Provider Business Mailing Address
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Address Line | 12300 SW 69TH PL
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City | PINECREST
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State | FL
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Zip | 33156-5436
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Country | US
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Telephone | 954-258-3899
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CURTIS JOHN CORGAN
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Credential | MD
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Telephone | 954-258-3899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME 93407
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License Number State | FL
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