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General NPI Number Information
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NPI Number | 1922218114
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Entity Type | Individual
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Provider Name | JOHN RICHARD KORTE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 300 COLLEGE PARK AVE 330 ST. JOSEPH HALL
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City | DAYTON
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State | OH
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Zip | 45409-2670
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Country | US
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Telephone | 937-229-2169
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Fax | 937-229-3900
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Provider Business Mailing Address
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Address Line | 115 COLONIAL LN
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City | KETTERING
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State | OH
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Zip | 45429-2151
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Country | US
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Telephone | 937-433-1862
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2149
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License Number State | OH
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