Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 36719 | TX |
Y | 213EG0000X | General Practice | 36719 | TX |
NPI | 1003421157 |
---|---|
Provider Name | Dr. Joshua Michael Corcran |
First Address | North Las Vegas, NV 89081-8006 |
Second Address | Fort Worth, TX 76132-1427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2020 |
Last Update Date | 14/09/2020 |