Provider Demographics
NPI:1235335472
Name:JEPPSON, CORINNE NICOLE (DO)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:NICOLE
Last Name:JEPPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:5206 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-5251
Practice Address - Country:US
Practice Address - Phone:210-595-5300
Practice Address - Fax:210-614-8740
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017162207V00000X
FLOS11306207V00000X
TXQ1836207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349441102Medicaid
TXP01547630OtherRAILROAD MEDICARE
TXP01547630OtherRAILROAD MEDICARE