Provider Demographics
NPI:1891809240
Name:PHILPOT, COREY D (MD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:D
Last Name:PHILPOT
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 1:3006 S MARYLAND PKWY STE 510
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2224
Mailing Address - Country:US
Mailing Address - Phone:702-697-5234
Mailing Address - Fax:
Practice Address - Street 1:3006 S MARYLAND PKWY STE 510
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2224
Practice Address - Country:US
Practice Address - Phone:702-697-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV131762080P0203X
WAMD00047905207L00000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA34528100Medicaid
AZ446280Medicaid
WA34528100Medicaid
AZ446280Medicaid
I19949Medicare UPIN