Provider Demographics
NPI:1255629762
Name:SELF, CORINNE M (MD)
Entity type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:M
Last Name:SELF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CORINNE
Other - Middle Name:M
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1846 E INNOVATION PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-1963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1846 E INNOVATION PARK DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1963
Practice Address - Country:US
Practice Address - Phone:520-829-9987
Practice Address - Fax:833-989-2161
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR72765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine