Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD.200276 | LA |
N | 111NI0900X | Internist | MD.200276 | LA |
Y | 207RN0300X | Nephrologist | 30121 | AL |
NPI | 1063602449 |
---|---|
Provider Name | Dr. Jesse Michael Corbello |
First Address | Mobile, AL 36608-2413 |
Second Address | Mobile, AL 36608-3078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2007 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1-06690-7 | (05) | LA |
51108316 | BCBS (01) | AL |