Organization
DR. RICHARD D. CORLEY, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD D. CORLEY M.D. (DIRECT OWNER)
(309) 674-2822
Entity
Organization
Contact information
Practice address
416 ST. MARK CT., #106, PEORIA, IL 61603-1928
(309) 674-2822
(309) 674-4250
Mailing address
416 ST. MARK CT., #106, PEORIA, IL 61603-1928
(309) 674-2822
(309) 674-4250
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
036-037-295
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036037295
—
IL
Enumeration date
12/09/2009
Last updated
12/09/2009
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