Individual
MR. GEORGE MARK CORAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
NAVAHCS 500 N HWY 89, PRESCOTT, AZ 86313
(928) 445-4860
(928) 717-7423
Mailing address
11850 E ARABIAN LN, DEWEY, AZ 86327-6001
(928) 445-4860
(928) 717-7423
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
11982
IL
Other
Enumeration date
08/28/2006
Last updated
07/08/2007
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