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NPI Code Detail

MEDICARE: JOHN R CORKERY MD

MEDICARE: JOHN R CORKERY 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
1207Q00000XFamily Medicine Physician154890-1205UT

General Provider Information

NPI Number : 1396892220
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN R CORKERY MD
Provider Business Mailing Address
First Line : PO BOX 307
Second Line :
City : BOUNTIFUL
State : UT
Zip : 84011-0307
Country : US
Telephone Number : 801-294-6907
Fax Number : 801-294-6917
Provider Business Practice Location Address
First Line : 441 S REDWOOD RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84104-3539
Country : US
Telephone Number : 801-973-2588
Fax Number : 801-973-6985
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2007
Last Update Date : 11/09/2015

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