Individual
DAVID DICKSON CORLEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 W TERRELL AVE STE 500, FORT WORTH, TX 76104-2810
(817) 252-5000
(817) 252-5060
Mailing address
1300 W TERRELL AVE STE 500, FORT WORTH, TX 76104-2810
(817) 252-5000
(817) 252-5060
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
H4251
TX
207RI0011X
Interventional Cardiology Physician
H4251
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110188988
RAIL ROAD MEDICARE
TX
05
—
1253643-02
—
TX
05
—
125364305
—
TX
01
—
85K259
BLLUE CROSS
TX
Enumeration date
10/05/2005
Last updated
08/18/2022
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