Provider Demographics
NPI:1851854574
Name:CORBRIDGE, TREG (DPM)
Entity Type:Individual
Prefix:DR
First Name:TREG
Middle Name:
Last Name:CORBRIDGE
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 1:903 S MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3112
Mailing Address - Country:US
Mailing Address - Phone:208-690-0683
Mailing Address - Fax:
Practice Address - Street 1:903 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3112
Practice Address - Country:US
Practice Address - Phone:801-515-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11824171-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery