Provider Demographics
NPI:1043223381
Name:KESSLER, CORBY S (MD)
Entity Type:Individual
Prefix:
First Name:CORBY
Middle Name:S
Last Name:KESSLER
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 1:935 TRANCAS ST
Mailing Address - Street 2:STE 1B
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2932
Mailing Address - Country:US
Mailing Address - Phone:707-255-6115
Mailing Address - Fax:707-255-6613
Practice Address - Street 1:935 TRANCAS ST
Practice Address - Street 2:STE 1B
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2932
Practice Address - Country:US
Practice Address - Phone:707-255-6115
Practice Address - Fax:707-255-6613
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76902208100000X, 2081P0004X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G769020OtherMEDICARE PROV #
CA037930OtherHEALTHNET
CA411753977OtherBC OF CA
CAP00081783OtherRR MEDICARE
CA138791900OtherUS DEPT OF LABOR
CA00G769021OtherMEDI-CAL
CAF26750OtherUPIN