Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 60102 | KS |
N | 1223E0200X | Endodontist | 60102 | KS |
NPI | 1144294562 |
---|---|
Provider Name | Dr. James Robert Corcoran |
First Address | Fort Campbell, KY 42223-5369 |
Second Address | Fort Campbell, KY 42223-5369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 08/07/2007 |