Provider Demographics
NPI:1114112042
Name:CORNISH, DAVID JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:CORNISH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:314 GOFF MOUNTAIN RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-6602
Mailing Address - Country:US
Mailing Address - Phone:304-776-7990
Mailing Address - Fax:304-776-7974
Practice Address - Street 1:314 GOFF MOUNTAIN RD
Practice Address - Street 2:SUITE #1
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-6602
Practice Address - Country:US
Practice Address - Phone:304-776-7990
Practice Address - Fax:304-776-7974
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV10399213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine