Provider Demographics
NPI:1568529105
Name:COREY, RICHARD PAUL (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PAUL
Last Name:COREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 300 W STE 500
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3312
Mailing Address - Country:US
Mailing Address - Phone:801-357-7704
Mailing Address - Fax:801-357-7424
Practice Address - Street 1:1055 N 300 W STE 500
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3312
Practice Address - Country:US
Practice Address - Phone:801-357-7704
Practice Address - Fax:801-357-7424
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043978207W00000X
UT52668101205207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4532COOtherREGENCE INSURANCE NUM
WA4539COOtherREGENCE INSURANCE NUM
WA8398349Medicaid
WA0186949OtherDEPT OF LABOR AND INDUSTR
WA3933COOtherREGENCE INSURANCE NUM
WA5393COOtherREGENCE INSURANCE NUM
WA8804249Medicare ID - Type UnspecifiedMEDICARE NUMBER
WA0186949OtherDEPT OF LABOR AND INDUSTR
WA3933COOtherREGENCE INSURANCE NUM