NPI | 1770635062 |
---|---|
Former Name | DEEDRA G CORZART |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: IL 036107216) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036107216) |
Enumeration Date | 2007-01-17 |
Last Update Date | 2020-12-28 |