Organization
COREY L DETLEFS MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COREY L DETLEFS MD (PRESIDENT)
(602) 340-0201
Entity
Organization
Contact information
Practice address
2320 N 3RD ST, PHOENIX, AZ 85004-1303
(602) 340-0201
(602) 441-5115
Mailing address
2320 N 3RD ST, PHOENIX, AZ 85004-1303
(602) 340-0201
(602) 441-5115
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
19043
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140179
—
AZ
Enumeration date
11/01/2006
Last updated
12/06/2007
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