Provider Demographics
NPI:1659401834
Name:CORCORAN, JACQUELINE E (DO)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:E
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1400 SOUTH DOBSON ROAD
Mailing Address - Street 2:ATTN: BMG HOSPITALIST TEAM/ AMANDA GUMP
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202
Mailing Address - Country:US
Mailing Address - Phone:480-412-6788
Mailing Address - Fax:480-412-6848
Practice Address - Street 1:1400 SOUTH DOBSON ROAD
Practice Address - Street 2:ATTN: BMG HOSPITALIST TEAM/ AMANDA GUMP
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-412-6788
Practice Address - Fax:480-412-6848
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101015935207R00000X, 208M00000X
AZ006360207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1659401834OtherNPI
MI5821617OtherBCBS
MI114632103Medicaid
MI114632103Medicaid