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1235219676

NPI Code Detail

MEDICARE: JANE CORBOY MD

MEDICARE: JANE CORBOY MD

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
1	207Q00000X	Family Medicine Physician	G3248	TX
2	207Q00000X	Family Medicine Physician	MD150490	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235219676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE CORBOY MD

Provider Business Mailing Address
First Line	:	1620 E 12TH ST
Second Line	:	PO BOX 1520
City	:	THE DALLES
State	:	OR
Zip	:	97058-3213
Country	:	US
Telephone Number	:	541-296-9151
Fax Number	:	541-296-9156

Provider Business Practice Location Address
First Line	:	1620 E 12TH ST
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-3213
Country	:	US
Telephone Number	:	541-296-9151
Fax Number	:	541-296-9156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	11/13/2014

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Directions to “ JANE CORBOY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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