MEDICARE: WILLIAM F CORELL 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	17781	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04165CORELL	OTHER		PREMERA BLUE CROSS

General Provider Information

NPI Number	:	1831162163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM F CORELL MD

Provider Business Mailing Address
First Line	:	3424 S GRAND BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-2621
Country	:	US
Telephone Number	:	509-838-5800
Fax Number	:	509-838-4042

Provider Business Practice Location Address
First Line	:	3424 S GRAND BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-2621
Country	:	US
Telephone Number	:	509-838-5800
Fax Number	:	509-838-4042

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM FRANK CORELL
Credential	:	MD
Telephone Number	:	509-838-5800

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	12/29/2008

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