Provider Demographics
NPI:1013127497
Name:SANT, CORY DEAN (IDC)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:DEAN
Last Name:SANT
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 PLUM ORCHARD PL
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-8812
Mailing Address - Country:US
Mailing Address - Phone:912-674-2103
Mailing Address - Fax:912-882-3693
Practice Address - Street 1:USS RHODE ISLAND SSBN 740 (BLUE)
Practice Address - Street 2:1059 USS GEORGIA AVE
Practice Address - City:KINGS BAY
Practice Address - State:GA
Practice Address - Zip Code:31547
Practice Address - Country:US
Practice Address - Phone:912-573-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman