Provider Demographics
NPI:1760403364
Name:PILLING, CORY A (DPM)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:A
Last Name:PILLING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5577
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-5577
Mailing Address - Country:US
Mailing Address - Phone:208-678-2727
Mailing Address - Fax:208-678-1477
Practice Address - Street 1:676 SHOUP AVE W STE 12
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4615
Practice Address - Country:US
Practice Address - Phone:208-733-0436
Practice Address - Fax:208-733-0438
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP187213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807346001Medicaid
ID1369188OtherMEDICARE
IDD08608980OtherMEDICARE DME SUBMITTER ID
ID000010152082OtherBLUE SHIELD
IDP2428OtherBLUE CROSS
IDP2427OtherBLUE CROSS
ID000010152083OtherBLUE SHIELD
ID8073460001Medicaid
ID000010152082OtherBLUE SHIELD
ID5631680001Medicare NSC