Provider Demographics
NPI:1518350339
Name:JUANITO R CORPUS MD
Entity Type:Organization
Organization Name:JUANITO R CORPUS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIBY
Authorized Official - Middle Name:P
Authorized Official - Last Name:CORPUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-773-5039
Mailing Address - Street 1:1002 S 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-3404
Mailing Address - Country:US
Mailing Address - Phone:863-773-5039
Mailing Address - Fax:863-773-6490
Practice Address - Street 1:1002 S 9TH AVE
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3404
Practice Address - Country:US
Practice Address - Phone:863-773-5039
Practice Address - Fax:863-773-6490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty