Provider Demographics
NPI:1881979391
Name:CORCORAN, DANIEL M (DVM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:CORCORAN
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 N CENTER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-5084
Mailing Address - Country:US
Mailing Address - Phone:480-275-7017
Mailing Address - Fax:
Practice Address - Street 1:744 N CENTER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5084
Practice Address - Country:US
Practice Address - Phone:480-275-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVT 60014477174M00000X
OR6824174M00000X
AZ6239174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian