MEDICARE: DR. DOUGLAS JAMES CORKUM 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	207P00000X	Emergency Medicine Physician	MD030446E	PA

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	:	1508823931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS JAMES CORKUM MD

Provider Business Mailing Address
First Line	:	3515 WASHINGTON RD
Second Line	:
City	:	MCMURRAY
State	:	PA
Zip	:	15317-3063
Country	:	US
Telephone Number	:	724-229-2422
Fax Number	:	724-229-2429

Provider Business Practice Location Address
First Line	:	3515 WASHINGTON RD
Second Line	:
City	:	MCMURRAY
State	:	PA
Zip	:	15317-3063
Country	:	US
Telephone Number	:	724-229-2422
Fax Number	:	724-229-2429

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	07/08/2007

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