Provider Demographics
NPI:1609850973
Name:COREY, MATTHEW W (PA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:W
Last Name:COREY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14208 N BURSAGE DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3186
Mailing Address - Country:US
Mailing Address - Phone:480-471-8716
Mailing Address - Fax:
Practice Address - Street 1:2000 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2443
Practice Address - Country:US
Practice Address - Phone:602-246-5747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2047207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ453051001OtherGROUP HEALTH GROUP NUMBER
AZ86-0373636OtherHUMANA GROUP
AZ39-81220OtherEVERCARE GROUP
AZAW1436OtherHEALTHNET GROUP
AZ453051001OtherGROUP HEALTH GROUP NUMBER
AZAW1436OtherHEALTHNET GROUP
AZ86-0373636OtherHUMANA GROUP
AZ65874Medicare ID - Type Unspecified