Provider Demographics
NPI:1942288394
Name:COREY, CLYDE LELAND (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:LELAND
Last Name:COREY
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 1:919 GRAHAM DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6408
Mailing Address - Country:US
Mailing Address - Phone:281-516-6530
Mailing Address - Fax:281-290-9824
Practice Address - Street 1:919 GRAHAM DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6408
Practice Address - Country:US
Practice Address - Phone:281-516-6530
Practice Address - Fax:281-290-9824
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208800000-UROLOGY208800000X
TXH4250208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096750701Medicaid
TXF58501Medicare UPIN
TX85T513Medicare PIN
TX340013089Medicare PIN