Provider Demographics
NPI:1184651424
Name:CORUM, BRYAN G (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:G
Last Name:CORUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:613 ELIZABETH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2221
Mailing Address - Country:US
Mailing Address - Phone:361-884-5900
Mailing Address - Fax:361-884-5910
Practice Address - Street 1:613 ELIZABETH ST STE 200
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2221
Practice Address - Country:US
Practice Address - Phone:361-884-5900
Practice Address - Fax:361-884-5910
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1505213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU79913Medicare UPIN