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1609984988

NPI Code Detail

MEDICARE: ELWOOD J CORRY JR. MD

MEDICARE: ELWOOD J CORRY JR. 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	1764831205	UT

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	17643	OTHER	UT	PEHP
3	QM0000000728	OTHER	UT	ALTIUS
4	107006223101	OTHER	UT	SELECT HEALTH
5	2657	OTHER	UT	DESERET HEALTHCARE TRUST
6	87029387384062B005	OTHER	UT	TRICARE
7	870293873C01	OTHER	UT	EMI HEALTH

General Provider Information

NPI Number	:	1609984988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELWOOD J CORRY JR. MD

Provider Business Mailing Address
First Line	:	830 N 2000 W
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-4047
Country	:	US
Telephone Number	:	801-756-3511
Fax Number	:	801-443-1164

Provider Business Practice Location Address
First Line	:	830 N 2000 W
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-4047
Country	:	US
Telephone Number	:	801-756-3511
Fax Number	:	801-443-1164

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

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	04/29/2013

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Directions to “ ELWOOD J CORRY JR. 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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