Provider Demographics
NPI:1457331803
Name:CORNELL, ROBERT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:CORNELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 4590
Mailing Address - Street 2:DEPT 04
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4590
Mailing Address - Country:US
Mailing Address - Phone:713-652-5011
Mailing Address - Fax:713-654-4056
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:SUITE 1700
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:713-652-5011
Practice Address - Fax:713-654-4056
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL6016208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163244001Medicaid
TX8B2127Medicare PIN
TXH95522Medicare UPIN