Provider Demographics
NPI:1477262764
Name:ANNIS, KORY DAVID
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:DAVID
Last Name:ANNIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 E THAYER AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-5014
Mailing Address - Country:US
Mailing Address - Phone:701-595-9564
Mailing Address - Fax:
Practice Address - Street 1:2403 E THAYER AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-5014
Practice Address - Country:US
Practice Address - Phone:701-595-9564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172A00000XOther Service ProvidersDriver