Corey L Detlefs MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

19043 Issued in AZ

Legal business name

COREY L DETLEFS MD

Practice address

2320 N 3Rd St
Phoenix, AZ 85004-1303

Phone

(602) 340-0201

Fax

(602) 441-5115

NPI assigned

Nov 1, 2006

Last updated

Dec 6, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Corey L Detlefs, MD

Title

President

Phone

(602) 340-0201

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196899200000",
    "number": "1396822482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 N 3RD ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041303",
            "telephone_number": "602-340-0201",
            "fax_number": "602-441-5115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 N 3RD ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041303",
            "telephone_number": "602-340-0201",
            "fax_number": "602-441-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COREY L DETLEFS MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-12-06",
        "status": "A",
        "authorized_official_last_name": "DETLEFS",
        "authorized_official_first_name": "COREY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-340-0201",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "19043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140179",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber Nicole Core, RD
• Gary J Core, DDS
• Corebella Health and Wellness LLC (Brightview Health)
• Karla Corella Velarde
• Stephanie Danielle Corella, FNP
• Corey S Bruce MD LTD
• Matthew W Corey, PA
• Roman Michael Corey
• Tobriah Lee Marie Corfield-Lovegren, CNM/NP
• Meredith Corley, LMT

• Surgery Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.