Provider Demographics
NPI:1730162017
Name:CORRIGAN, GREGG D (DPM)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:D
Last Name:CORRIGAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 BRADY ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-1519
Mailing Address - Country:US
Mailing Address - Phone:563-323-9876
Mailing Address - Fax:563-323-1032
Practice Address - Street 1:2839 BRADY ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-1519
Practice Address - Country:US
Practice Address - Phone:563-323-9876
Practice Address - Fax:563-323-1032
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0473213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4709770001Medicare NSC
IAI8869Medicare PIN
IAT80097Medicare UPIN