Provider Demographics
NPI:1508193152
Name:CORBIN, GREG
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:
Last Name:CORBIN
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 1:3008 N 47TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7745
Mailing Address - Country:US
Mailing Address - Phone:602-231-0413
Mailing Address - Fax:602-218-6422
Practice Address - Street 1:3008 N 47TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7745
Practice Address - Country:US
Practice Address - Phone:602-231-0413
Practice Address - Fax:602-218-6422
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07436438-K171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor