Provider Demographics
NPI:1689065559
Name:CORONA, PHILLIP BARRETT (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:BARRETT
Last Name:CORONA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:970 S ACADIA RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4978
Mailing Address - Country:US
Mailing Address - Phone:985-446-2335
Mailing Address - Fax:985-446-2337
Practice Address - Street 1:970 S ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4978
Practice Address - Country:US
Practice Address - Phone:985-446-2335
Practice Address - Fax:985-446-2337
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM.200059213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery