Provider Demographics
NPI:1003846882
Name:CORRAL, DAVID F (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:CORRAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6410 SOUTHWEST BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3914
Mailing Address - Country:US
Mailing Address - Phone:817-377-9100
Mailing Address - Fax:817-377-9100
Practice Address - Street 1:6410 SOUTHWEST BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3914
Practice Address - Country:US
Practice Address - Phone:817-377-9100
Practice Address - Fax:817-377-3444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH7400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098282903Medicaid
TX098282903Medicaid
TXE77602Medicare UPIN