Provider Demographics
NPI:1295964153
Name:CORPUS, CAROLINE M (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:M
Last Name:CORPUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-2837
Mailing Address - Country:US
Mailing Address - Phone:870-875-8838
Mailing Address - Fax:870-875-8838
Practice Address - Street 1:310 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4569
Practice Address - Country:US
Practice Address - Phone:870-862-4216
Practice Address - Fax:870-862-9011
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7213207W00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP01082504OtherRAILROAD MEDICARE
AR194054001Medicaid
AR194054001Medicaid
AR4R123C263Medicare PIN