Provider Demographics
NPI:1104259548
Name:CORBIN, BRADLEY THOMAS
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:THOMAS
Last Name:CORBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 KINGSLEY AVE STE 390
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4484
Mailing Address - Country:US
Mailing Address - Phone:904-639-2260
Mailing Address - Fax:904-272-1986
Practice Address - Street 1:1825 KINGSLEY AVE STE 390
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4484
Practice Address - Country:US
Practice Address - Phone:904-639-2260
Practice Address - Fax:904-272-1986
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME158618207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology