Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 10399 | WV |
NPI | 1114112042 |
---|---|
Provider Name | Dr. David James Cornish |
First Address | Cross Lanes, WV 25313-6602 |
Second Address | Cross Lanes, WV 25313-6602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2007 |
Last Update Date | 13/09/2007 |