Provider Demographics
NPI:1144225160
Name:CORPUS, VIRGINIA G (MD, FACP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:G
Last Name:CORPUS
Suffix:
Gender:F
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 E LOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8255
Mailing Address - Country:US
Mailing Address - Phone:575-556-3241
Mailing Address - Fax:575-526-6303
Practice Address - Street 1:4371 E LOHMAN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-556-3241
Practice Address - Fax:575-526-6303
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0106207R00000X
NMMD2007-0446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM81605323Medicaid
NM346726304OtherMEDICARE
TX1410490-03Medicaid
NM81605323OtherMEDICARE
NM81605323OtherMEDICARE