Provider Demographics
NPI:1083890602
Name:GEORGE CORRENT PA
Entity Type:Organization
Organization Name:GEORGE CORRENT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CORRENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-370-1011
Mailing Address - Street 1:11091 PHOENIX WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8952
Mailing Address - Country:US
Mailing Address - Phone:239-566-9209
Mailing Address - Fax:239-566-9209
Practice Address - Street 1:11091 PHOENIX WAY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8952
Practice Address - Country:US
Practice Address - Phone:239-566-9209
Practice Address - Fax:239-566-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50295207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042736500Medicaid
FLE15404Medicare UPIN