Provider Demographics
NPI:1609984988
Name:CORRY, ELWOOD J JR (MD)
Entity Type:Individual
Prefix:
First Name:ELWOOD
Middle Name:J
Last Name:CORRY
Suffix:JR
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 1:830 N 2000 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4047
Mailing Address - Country:US
Mailing Address - Phone:801-756-3511
Mailing Address - Fax:801-443-1164
Practice Address - Street 1:830 N 2000 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-4047
Practice Address - Country:US
Practice Address - Phone:801-756-3511
Practice Address - Fax:801-443-1164
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1764831205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT08829Medicaid
UT17643OtherPEHP
UTQM0000000728OtherALTIUS
UT107006223101OtherSELECT HEALTH
UT2657OtherDESERET HEALTHCARE TRUST
UT87029387384062B005OtherTRICARE
UT870293873C01OtherEMI HEALTH
UTQM0000000728OtherALTIUS
UT080027692Medicare ID - Type UnspecifiedRAILROAD MEDICARE
UT2657OtherDESERET HEALTHCARE TRUST
UTA03137Medicare UPIN