MEDICARE: KEITH F. KORVER, M.D., INC.

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	208600000X	Surgery Physician
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

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

General Provider Information

NPI Number	:	1376598573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEITH F. KORVER, M.D., INC.

Provider Business Mailing Address
First Line	:	3510 UNOCAL PL STE 207
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-0918
Country	:	US
Telephone Number	:	707-569-7860
Fax Number	:	707-545-5408

Provider Business Practice Location Address
First Line	:	721 RIVER DR
Second Line	:	STE A
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-5402
Country	:	US
Telephone Number	:	707-573-6166
Fax Number	:	707-573-6165

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEITH FORREST KORVER
Credential	:	M.D.
Telephone Number	:	707-569-7860

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/15/2021

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