Provider Demographics
NPI:1295720985
Name:CORN, CHRISTA CARMAN (MD)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:CARMAN
Last Name:CORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:171 W BOCA RATON RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6250
Mailing Address - Country:US
Mailing Address - Phone:602-246-8666
Mailing Address - Fax:602-246-6082
Practice Address - Street 1:333 W THOMAS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4417
Practice Address - Country:US
Practice Address - Phone:602-246-8666
Practice Address - Fax:602-246-6082
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2014-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ18489208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE28363Medicare UPIN
AZZ24214Medicare PIN