Provider Demographics
NPI:1790120681
Name:GOOLSBY, COREY MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:MICHAEL
Last Name:GOOLSBY
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 1:3301 S ALAMEDA ST STE 306
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1876
Mailing Address - Country:US
Mailing Address - Phone:361-884-3984
Mailing Address - Fax:361-452-3262
Practice Address - Street 1:3301 S ALAMEDA ST
Practice Address - Street 2:STE 306
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-884-3984
Practice Address - Fax:361-452-3262
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2193213E00000X, 213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program