Provider Demographics
NPI:1528141710
Name:HECTOR CORZO MD PA
Entity type:Organization
Organization Name:HECTOR CORZO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-541-3362
Mailing Address - Street 1:7955 66TH ST
Mailing Address - Street 2:STE.D
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2161
Mailing Address - Country:US
Mailing Address - Phone:727-541-3362
Mailing Address - Fax:727-544-4015
Practice Address - Street 1:7955 66TH ST
Practice Address - Street 2:STE.D
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2161
Practice Address - Country:US
Practice Address - Phone:727-541-3362
Practice Address - Fax:727-544-4015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27258207Q00000X, 2084P0800X
FLME00357732084P0800X, 2084P0804X
FL830052363L00000X, 363LP0808X
FL2786242363LP0808X
FL888372363LP0808X
FL2835092363LP0808X
FL1731582363LP0808X
FLME989562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253886500Medicaid
FL253886500Medicaid
FLK0137Medicare ID - Type UnspecifiedGROUP#
FL253886500Medicaid