Provider Demographics
NPI:1932412970
Name:CORPUS, IAN MANUEL GUERRERO (MD)
Entity type:Individual
Prefix:
First Name:IAN MANUEL
Middle Name:GUERRERO
Last Name:CORPUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 CYPRESS E WAY 10
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-9275
Mailing Address - Country:US
Mailing Address - Phone:239-431-7906
Mailing Address - Fax:239-597-0338
Practice Address - Street 1:3437 125TH DR NE UNIT C
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-6139
Practice Address - Country:US
Practice Address - Phone:701-341-1780
Practice Address - Fax:701-341-1780
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN58740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine