Individual
PRUDENCIO C CORRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
673 RITTER DR, GLEN MORGAN, WV 25813-7707
(304) 252-0775
(304) 255-6688
Mailing address
673 RITTER DR, GLEN MORGAN, WV 25813-7707
(304) 252-0775
(304) 255-6688
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
5862
WV
207Y00000X
Otolaryngology Physician
9578
WV
207YX0602X
Otolaryngic Allergy Physician
Primary
9578
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0101068000
—
WV
Enumeration date
05/04/2006
Last updated
12/07/2020
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