Basic Information
| Provider Information | |||||||||
| NPI: | 1689848525 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORBIN LONDON MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1007 CUMBERLAND FALLS HWY | ||||||||
| Address2: | |||||||||
| City: | CORBIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065280305 | ||||||||
| FaxNumber: | 6065234368 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007 CUMBERLAND FALLS HWY | ||||||||
| Address2: | |||||||||
| City: | CORBIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065280305 | ||||||||
| FaxNumber: | 6065234368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2008 | ||||||||
| LastUpdateDate: | 07/28/2011 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6065280305 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1086037 | KY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 39404 | KY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208100000X | 002008 | KY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 207Q00000X | 1033143 | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.