Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | BP10053703 | TX |
N | 111NI0900X | Internist | BP10053703 | TX |
Y | 207RR0500X | Rheumatology | 02005894A | IN |
N | 208D00000X | General Practice Physician | R1977 | TX |
NPI | 1134580863 |
---|---|
Provider Name | Dr. Theodore Thomas Korty |
First Address | Corpus Christi, TX 78412-4913 |
Second Address | Corpus Christi, TX 78412-4913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2016 |
Last Update Date | 02/06/2020 |