Provider Demographics
NPI:1316965270
Name:GUY CORKILL, M.D. INC.
Entity type:Organization
Organization Name:GUY CORKILL, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORKILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-243-0570
Mailing Address - Street 1:2701 EUREKA WAY
Mailing Address - Street 2:STE 1I
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0228
Mailing Address - Country:US
Mailing Address - Phone:530-243-0570
Mailing Address - Fax:530-243-3356
Practice Address - Street 1:2701 EUREKA WAY
Practice Address - Street 2:STE 1I
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0228
Practice Address - Country:US
Practice Address - Phone:530-243-0570
Practice Address - Fax:530-243-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26572207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316965270Medicaid
CAZZZ02454ZMedicare PIN
CAC03857Medicare UPIN