Provider Demographics
NPI:1447242110
Name:VEZA, CORAZON A (MD)
Entity Type:Individual
Prefix:DR
First Name:CORAZON
Middle Name:A
Last Name:VEZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:E TOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2763
Mailing Address - Country:US
Mailing Address - Phone:270-769-0167
Mailing Address - Fax:270-769-0168
Practice Address - Street 1:1118 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:E TOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2763
Practice Address - Country:US
Practice Address - Phone:270-769-0167
Practice Address - Fax:270-769-0168
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23167207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1194923904OtherMEDICARE ID GRP #
KY64231673Medicaid
KY64231673Medicaid