Provider Demographics
NPI:1538491204
Name:CURTIS JOHN CORGAN LLC
Entity Type:Organization
Organization Name:CURTIS JOHN CORGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-258-3899
Mailing Address - Street 1:12300 SW 69TH PL
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5436
Mailing Address - Country:US
Mailing Address - Phone:954-258-3899
Mailing Address - Fax:
Practice Address - Street 1:12300 SW 69TH PL
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-5436
Practice Address - Country:US
Practice Address - Phone:954-258-3899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 93407174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275013900Medicaid
FL275013900Medicaid
FLH58111Medicare UPIN