Individual
MR. JOSHUA DERRELL CORLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
721 BETTER NOW PLZ, ADA, OK 74820-2279
(580) 272-0025
(580) 272-6659
Mailing address
902 ARLINGTON CTR, ADA, OK 74820-2883
(580) 272-0025
(580) 272-6659
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1538
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20083400A
—
OK
01
—
245617201
MEDICARE
OK
01
—
PA1538
PA MEDICAL LICENSE
OK
Enumeration date
05/22/2006
Last updated
03/07/2023
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