Provider Demographics
NPI:1588848717
Name:CORBETT, ALLEN BLAIR (DO)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:BLAIR
Last Name:CORBETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:602-214-6148
Mailing Address - Fax:602-214-6149
Practice Address - Street 1:3525 W CALAVAR RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-5512
Practice Address - Country:US
Practice Address - Phone:602-938-8150
Practice Address - Fax:602-938-9277
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2013-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ241555001Medicaid
AZ241555001Medicaid