Provider Demographics
NPI:1144333709
Name:CORPUS, ED TOJINO JR (MD)
Entity type:Individual
Prefix:DR
First Name:ED
Middle Name:TOJINO
Last Name:CORPUS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:317 BREWSTER ST E
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:ND
Mailing Address - Zip Code:58341-1653
Mailing Address - Country:US
Mailing Address - Phone:701-324-4134
Mailing Address - Fax:701-324-4205
Practice Address - Street 1:317 BREWSTER ST E
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:ND
Practice Address - Zip Code:58341-1653
Practice Address - Country:US
Practice Address - Phone:701-324-4134
Practice Address - Fax:701-324-4205
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND5394208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDA62609Medicare UPIN