Provider Demographics
NPI:1164749669
Name:KORAB, JEFF M (DPM)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:M
Last Name:KORAB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S KYRENE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4722
Mailing Address - Country:US
Mailing Address - Phone:480-561-3734
Mailing Address - Fax:480-497-3947
Practice Address - Street 1:30 S KYRENE RD STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-4722
Practice Address - Country:US
Practice Address - Phone:480-561-3734
Practice Address - Fax:480-497-3947
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPO60277402213ES0103X
NV1007213ES0103X
AZPOD-001027213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2017492Medicaid
WA2017492Medicaid
WAG8909271Medicare PIN