MEDICARE: MERYANN CORZO 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	BP-10050700	TX
2	207Q00000X	Family Medicine Physician	R4381	TX

General Provider Information

NPI Number	:	1720498124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERYANN CORZO MD

Provider Business Mailing Address
First Line	:	3023 MARINA BAY DR
Second Line	:	STE 101
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2882
Country	:	US
Telephone Number	:	--
Fax Number	:

Provider Business Practice Location Address
First Line	:	3023 MARINA BAY DR
Second Line	:	STE 101
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2882
Country	:	US
Telephone Number	:	--
Fax Number	:

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

Provider Enumeration Date	:	05/07/2014
Last Update Date	:	07/09/2021

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