Provider Demographics
NPI:1578673067
Name:KORB, AMY C (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:KORB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 IRIS ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215
Mailing Address - Country:US
Mailing Address - Phone:720-299-4919
Mailing Address - Fax:
Practice Address - Street 1:1411 S POTOMAC ST
Practice Address - Street 2:STE 400
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4536
Practice Address - Country:US
Practice Address - Phone:303-695-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010446363AS0400X
TXPA05052363A00000X
COPA-2933363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00442154OtherRAILROAD MEDICARE
TX8Y1358OtherBLUE CROSS BLUE SHIELD
TX8Y1358OtherBLUE CROSS BLUE SHIELD
8J4848Medicare PIN
TXP00442154OtherRAILROAD MEDICARE