Provider Demographics
NPI:1023384500
Name:CORBALAN, FRANCISCO JAIME (MD)
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:JAIME
Last Name:CORBALAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 EXCHANGE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-4464
Mailing Address - Country:US
Mailing Address - Phone:802-388-7959
Mailing Address - Fax:
Practice Address - Street 1:1330 EXCHANGE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-4464
Practice Address - Country:US
Practice Address - Phone:802-388-7959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420013071208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics