Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 12377 | AZ |
Y | 111NI0900X | Internist | 12377 | AZ |
N | 207RI0200X | Infectious Disease | 12377 | AZ |
NPI | 1053350603 |
---|---|
Provider Name | Dr. John Gregory Corcoran |
First Address | Tucson, AZ 85711-3629 |
Second Address | Tucson, AZ 85711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 30/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D43817 | (02) | |
ZWDBCR01 | PTAN (01) | AZ |