Provider Demographics
NPI:1417695206
Name:SPIRES, CORINNE MARYSSA
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:MARYSSA
Last Name:SPIRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E MAIN ST STE A100
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4606
Mailing Address - Country:US
Mailing Address - Phone:928-596-4500
Mailing Address - Fax:928-596-4545
Practice Address - Street 1:117 E MAIN ST STE A100
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4606
Practice Address - Country:US
Practice Address - Phone:928-596-4500
Practice Address - Fax:928-596-4545
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ76930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine