Provider Demographics
NPI:1790183309
Name:HINTON, COREY CORDELL (CSFA)
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:CORDELL
Last Name:HINTON
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 MELCER DR STE 601
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4033
Mailing Address - Country:US
Mailing Address - Phone:214-227-2457
Mailing Address - Fax:214-764-0880
Practice Address - Street 1:2525 E PRINCE RD APT 27
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1146
Practice Address - Country:US
Practice Address - Phone:214-227-2457
Practice Address - Fax:214-764-0880
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2022-08-17
Deactivation Date:2020-04-10
Deactivation Code:
Reactivation Date:2020-05-06
Provider Licenses
StateLicense IDTaxonomies
AZ116716246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty