Provider Demographics
NPI:1013032218
Name:FEARHEILEY, COREY RAY (MD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:RAY
Last Name:FEARHEILEY
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 1:3747 BOWEN RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4826
Mailing Address - Country:US
Mailing Address - Phone:419-474-8443
Mailing Address - Fax:
Practice Address - Street 1:2201 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:254-526-7523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7175207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X6274OtherBCBS
TX8AB484OtherBCBS
TX8AS824OtherBCBS
TX8V5769OtherBCBS
TX8W1006OtherBCBS
TX8X9293OtherBCBS
TX8J8876Medicare PIN
TX8J8877Medicare PIN
TX8V5769OtherBCBS
TX8X6274OtherBCBS
TX8F6606Medicare PIN
TX8AS824OtherBCBS