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Individual

DR. CORY V TRICKETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
3183 W STATE ST, BRISTOL, TN 37620-1712
(423) 764-7131
(423) 245-3136
Mailing address
3551 ROGER BROOKE DR, MCHE-QD(CREDS), SAN ANTONIO, TX 78234-4504

Taxonomy

Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
10791
ND
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
3466
TN
207ND0101X
MOHS-Micrographic Surgery Physician
73663
GA

Other

Enumeration date
01/12/2007
Last updated
02/12/2019
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