Provider Demographics
NPI:1376650929
Name:JOHN D. CORBITT, JR. MD, INC
Entity Type:Organization
Organization Name:JOHN D. CORBITT, JR. MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DEWEY
Authorized Official - Last Name:CORBITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-439-1501
Mailing Address - Street 1:140 JOHN F KENNEDY DR
Mailing Address - Street 2:SUITE 142
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6608
Mailing Address - Country:US
Mailing Address - Phone:561-439-1501
Mailing Address - Fax:561-439-9902
Practice Address - Street 1:140 JOHN F KENNEDY DR
Practice Address - Street 2:SUITE 142
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-6608
Practice Address - Country:US
Practice Address - Phone:561-439-1501
Practice Address - Fax:561-439-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0011628174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54930Medicare UPIN
FLI06054Medicare UPIN
FLH95156Medicare UPIN