MEDICARE: JAMES T CORBETT PA-C

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	363A00000X	Physician Assistant	PA10003454	WA
2	363A00000X	Physician Assistant	5180	AZ

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	:	1972577088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES T CORBETT PA-C

Provider Business Mailing Address
First Line	:	36 KLONDIKE RD
Second Line	:
City	:	REPUBLIC
State	:	WA
Zip	:	99166-9701
Country	:	US
Telephone Number	:	509-775-3153
Fax Number	:	509-775-8929

Provider Business Practice Location Address
First Line	:	1810 MESQUITE AVE STE B
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5886
Country	:	US
Telephone Number	:	928-453-4600
Fax Number	:

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	03/17/2018

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