Provider Demographics
NPI:1023067238
Name:CORKILL, ANTHONY G L (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G L
Last Name:CORKILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GUY
Other - Middle Name:L
Other - Last Name:CORKILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2701 EUREKA WAY
Mailing Address - Street 2:SUITE 1I
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0228
Mailing Address - Country:US
Mailing Address - Phone:530-243-0570
Mailing Address - Fax:530-243-3356
Practice Address - Street 1:2701 EUREKA WAY
Practice Address - Street 2:SUITE 1I
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0228
Practice Address - Country:US
Practice Address - Phone:530-243-0570
Practice Address - Fax:530-243-3356
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26572207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023067238Medicaid
CABQ954Medicare PIN