Provider Demographics
NPI:1851380802
Name:CORY, DON W (MD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:W
Last Name:CORY
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 1:1262 SIOUX RD
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-8780
Mailing Address - Country:US
Mailing Address - Phone:970-641-2999
Mailing Address - Fax:970-641-2999
Practice Address - Street 1:1262 SIOUX RD
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-8780
Practice Address - Country:US
Practice Address - Phone:970-641-2999
Practice Address - Fax:970-641-2999
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081771207LP2900X, 207Q00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081771Medicaid
IL036081771Medicaid
D05324Medicare UPIN