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RICHARD A CORLEY PA
>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1417020314
Individual Registrant: RICHARD A CORLEY PA
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
10820 MARVIN E JONES BLVD LIVE OAK, FL 32060 US
Tel: 386-658-5300 Fax: 386-658-5130
Tel: 386-658-5300 Fax: 386-658-5130
Contact information for business:
10820 MARVIN E. JONES BLVD. LIVE OAK, FL 32060 US
Tel: 386-658-5300 Fax: 386-658-5130
Tel: 386-658-5300 Fax: 386-658-5130
Registration Information:
NPI: 1417020314
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | FL | PA9102574 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| MEDICAID | FL | 05 |
