Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 01067781B | IN |
Y | 207VX0000X | Obstetrician | 33186 | OK |
NPI | 1164751525 |
---|---|
Provider Name | Juan Adrian Cornejo |
First Address | Duncan, OK 73533-1570 |
Second Address | Duncan, OK 73533-1570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2009 |
Last Update Date | 26/07/2018 |