Provider Demographics
NPI:1023006871
Name:CORNWELL, JANIS R (MD)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:R
Last Name:CORNWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W MAYFIELD RD
Mailing Address - Street 2:STE 200
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2083
Mailing Address - Country:US
Mailing Address - Phone:817-468-4689
Mailing Address - Fax:817-465-7872
Practice Address - Street 1:515 W MAYFIELD RD
Practice Address - Street 2:STE 200
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2083
Practice Address - Country:US
Practice Address - Phone:817-468-4689
Practice Address - Fax:817-465-7872
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9725207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099782702Medicaid
TX099782702Medicaid
TX88W490Medicare PIN