Provider Demographics
NPI:1235120866
Name:CORNELL, PETER E (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:E
Last Name:CORNELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76645-2621
Mailing Address - Country:US
Mailing Address - Phone:254-582-7433
Mailing Address - Fax:254-582-7626
Practice Address - Street 1:1311 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2621
Practice Address - Country:US
Practice Address - Phone:254-582-7433
Practice Address - Fax:254-582-7626
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0755213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12785Medicare UPIN
TX85Z790Medicare PIN