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NPI Code Detail

MEDICARE: ALEXIS CORBIN R.D.

MEDICARE: ALEXIS CORBIN R.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian1393OK

General Provider Information

NPI Number : 1073582631
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS CORBIN R.D.
Provider Business Mailing Address
First Line : 115 W 3RD ST
Second Line :
City : TULSA
State : OK
Zip : 74103-3421
Country : US
Telephone Number : 918-585-3045
Fax Number : 918-585-3047
Provider Business Practice Location Address
First Line : 115 W 3RD ST
Second Line :
City : TULSA
State : OK
Zip : 74103-3410
Country : US
Telephone Number : 918-585-3045
Fax Number : 918-585-3047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 07/08/2007

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