Provider Demographics
NPI:1073611513
Name:ARCHER, CORRIS E (MD)
Entity type:Individual
Prefix:
First Name:CORRIS
Middle Name:E
Last Name:ARCHER
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 1:8110 ROYAL PALM BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5795
Mailing Address - Country:US
Mailing Address - Phone:954-341-8288
Mailing Address - Fax:954-341-5165
Practice Address - Street 1:8110 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-341-8288
Practice Address - Fax:954-341-5165
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 102642207V00000X, 207V00000X
NY221702207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000163100Medicaid
FL90109OtherBC/BS
ILH33681Medicare UPIN
FLBT968XMedicare PIN