MEDICARE: DR. JOHN RICHARD KORTE PH.D.

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	103TC0700X	Clinical Psychologist	2149	OH

General Provider Information

NPI Number	:	1922218114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RICHARD KORTE PH.D.

Provider Business Mailing Address
First Line	:	115 COLONIAL LN
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-2151
Country	:	US
Telephone Number	:	937-433-1862
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 COLLEGE PARK AVE
Second Line	:	330 ST. JOSEPH HALL
City	:	DAYTON
State	:	OH
Zip	:	45409-2670
Country	:	US
Telephone Number	:	937-229-2169
Fax Number	:	937-229-3900

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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