Individual
DR. COREY L DETLEFS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1441 N 12TH ST FL 1, PHOENIX, AZ 85006-2837
(602) 521-5968
Mailing address
1441 N 12TH ST FL 1, PHOENIX, AZ 85006-2837
(602) 521-5968
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
04/21/2006
Last updated
11/20/2017
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