Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G9725 | TX |
NPI | 1023006871 |
---|---|
Provider Name | Janis R Cornwell |
First Address | Arlington, TX 76014-2083 |
Second Address | Arlington, TX 76014-2083 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 20/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
099782702 | (05) | TX |
C14775 | (02) |