Provider Demographics
NPI:1093914020
Name:GREGG D CORRIGAN DPM PC
Entity Type:Organization
Organization Name:GREGG D CORRIGAN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:D
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:563-323-9876
Mailing Address - Street 1:2839 BRADY ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-1519
Mailing Address - Country:US
Mailing Address - Phone:563-323-9876
Mailing Address - Fax:563-323-1032
Practice Address - Street 1:2839 BRADY ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-1519
Practice Address - Country:US
Practice Address - Phone:563-323-9876
Practice Address - Fax:563-323-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA473213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4709770001Medicare NSC
IAI8868Medicare PIN