Provider Demographics
NPI:1790727030
Name:CORSER, BRUCE CLAYTON (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:CLAYTON
Last Name:CORSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 E GALBRAITH RD STE A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2879
Mailing Address - Country:US
Mailing Address - Phone:513-721-7533
Mailing Address - Fax:513-721-1649
Practice Address - Street 1:5240 E GALBRAITH RD STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2879
Practice Address - Country:US
Practice Address - Phone:513-721-7533
Practice Address - Fax:513-721-1649
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046569207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20083380Medicaid
OH0515786Medicaid
IN248660AMedicare PIN
A80625Medicare UPIN
OH0531082Medicare PIN
OH4021576Medicare PIN