Provider Demographics
NPI:1316182553
Name:CORNWELL, JAYME R (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAYME
Middle Name:R
Last Name:CORNWELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 CRAWFORD CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2267
Mailing Address - Country:US
Mailing Address - Phone:817-573-3338
Mailing Address - Fax:817-573-3368
Practice Address - Street 1:1200 CRAWFORD AVE STE C
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-4560
Practice Address - Country:US
Practice Address - Phone:817-573-3338
Practice Address - Fax:817-573-3368
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1949213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty