Provider Demographics
NPI:1306994686
Name:COMPLETE PODIATRY PC
Entity type:Organization
Organization Name:COMPLETE PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:CORUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-884-5900
Mailing Address - Street 1:613 ELIZABETH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2221
Mailing Address - Country:US
Mailing Address - Phone:361-884-5900
Mailing Address - Fax:
Practice Address - Street 1:613 ELIZABETH ST STE 200
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2221
Practice Address - Country:US
Practice Address - Phone:361-884-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1505213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU79913Medicare UPIN