1932142254 NPI number — DR. DAVID E CORNELL DPM

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932142254 NPI number — DR. DAVID E CORNELL DPM

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CORNELL

Provider First Name:

DAVID

Provider Middle Name:

E

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

DPM

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1932142254

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/17/2009

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 3587

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

OMAHA

Provider Business Mailing Address State Name:

NE

Provider Business Mailing Address Postal Code:

68103-0587

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

402-345-6503

Provider Business Mailing Address Fax Number:

402-345-0309

Provider First Line Business Practice Location Address:

1207 S 13TH ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

OMAHA

Provider Business Practice Location Address State Name:

NE

Provider Business Practice Location Address Postal Code:

68108-0587

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

402-345-6503

Provider Business Practice Location Address Fax Number:

402-345-0309

Provider Enumeration Date:

06/14/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 213E00000X , with the licence number:  NE164 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2700158 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 349957400 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
• Identifier: 47078690200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 480018212 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0511113 . This is a "IOWA MEDICAID" identifier . This identifiers is of the category "OTHER".
• Identifier: 470786902 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 87404 . This is a "COVENTRY HEALTHCARE NE" identifier . This identifiers is of the category "OTHER".
• Identifier: 02584 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 470786902 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 47078690268108A001 . This is a "TRICARE FOR LIFE" identifier . This identifiers is of the category "OTHER".
• Identifier: 470786902 . This is a "HEALTHCARE PREFERRED" identifier . This identifiers is of the category "OTHER".