Provider Demographics
NPI:1154689040
Name:FIELDING, CORY M (MD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:M
Last Name:FIELDING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-393-2759
Mailing Address - Fax:270-780-0475
Practice Address - Street 1:484 GOLDEN AUTUMN WAY STE 201
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-6913
Practice Address - Country:US
Practice Address - Phone:290-393-2759
Practice Address - Fax:270-780-0475
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48217207RG0100X, 207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program