Provider Demographics
NPI:1487796637
Name:CHRISTA CORN, MD, PLLC
Entity type:Organization
Organization Name:CHRISTA CORN, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-246-8666
Mailing Address - Street 1:2040 W BETHANY HOME RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2445
Mailing Address - Country:US
Mailing Address - Phone:602-246-8666
Mailing Address - Fax:602-246-6082
Practice Address - Street 1:2040 W BETHANY HOME RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2445
Practice Address - Country:US
Practice Address - Phone:602-246-8666
Practice Address - Fax:602-246-6082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty