Active NPI
Corydon Louis Doerr, DDS
- General Practice Dentistry
- Jbsa Lackland, TX
National Provider Identifier
1023087079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 14491
- Practice address
- 2261 Hughes Ave Ste 153
Jbsa Lackland, TX 78236-9852 - Phone
- (210) 395-9661
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 14491 | TX | Primary |
Addresses
Primary practice location
2261 Hughes Ave Ste 153
Jbsa Lackland, TX 78236-9852
Mailing address
136 Tyndall PL
Langley Afb, VA 23665-1910
Phone (757) 764-7525
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14491 | TX | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568160000000",
"number": "1023087079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "136 TYNDALL PL",
"city": "LANGLEY AFB",
"state": "VA",
"postal_code": "236651910",
"telephone_number": "757-764-7525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2261 HUGHES AVE STE 153",
"city": "JBSA LACKLAND",
"state": "TX",
"postal_code": "782369852",
"telephone_number": "210-395-9661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOERR",
"first_name": "CORYDON",
"middle_name": "LOUIS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2019-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "14491",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jbsa Lackland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.