Provider Demographics
NPI:1760564108
Name:CORBETT, SCOTT R (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:CORBETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8120 PENN AVE S
Mailing Address - Street 2:STE 440
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1326
Mailing Address - Country:US
Mailing Address - Phone:952-920-0846
Mailing Address - Fax:952-920-0846
Practice Address - Street 1:3601 PARK CENTER BLVD STE 308
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2525
Practice Address - Country:US
Practice Address - Phone:952-920-0846
Practice Address - Fax:952-920-0846
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN41370204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN003560200Medicaid
70D62COOtherBC/BS PROVIDER ID
MN003560200Medicaid
70D62COOtherBC/BS PROVIDER ID