Provider Demographics
NPI:1225193105
Name:CORBIER, JEAN-RONEL (MD)
Entity Type:Individual
Prefix:
First Name:JEAN-RONEL
Middle Name:
Last Name:CORBIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 EDGEWATER CORP PKWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-4514
Mailing Address - Country:US
Mailing Address - Phone:704-541-9117
Mailing Address - Fax:704-541-9137
Practice Address - Street 1:1040 EDGEWATER CORP PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-4514
Practice Address - Country:US
Practice Address - Phone:704-541-9117
Practice Address - Fax:704-541-9137
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-019102080P0008X
NC2006019102084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905648Medicaid
SCNC1492Medicaid
NC144NEOtherBCBS ID
NC195352OtherMEDCOST ID
NC7235262OtherAETNA
NC5695931OtherCIGNA HEALTHCARE
SCNC1492Medicaid