Provider Demographics
NPI:1790716140
Name:CORBETT, JOHN STUART (C-PED)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STUART
Last Name:CORBETT
Suffix:
Gender:M
Credentials:C-PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12162 N RANCHO VISTOSO BLVD SUITE 140
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-1897
Mailing Address - Country:US
Mailing Address - Phone:520-469-7084
Mailing Address - Fax:520-469-7085
Practice Address - Street 1:12162 N RANCHO VISTOSO BLVD SUITE 140
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1897
Practice Address - Country:US
Practice Address - Phone:520-469-7084
Practice Address - Fax:520-469-7085
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5775810001Medicare NSC