Provider Demographics
NPI:1477589976
Name:DONALD E. CORNFORTH, MD, INC.
Entity Type:Organization
Organization Name:DONALD E. CORNFORTH, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORNFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-381-7545
Mailing Address - Street 1:PO BOX 2103
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93303-2103
Mailing Address - Country:US
Mailing Address - Phone:661-381-7545
Mailing Address - Fax:661-381-7546
Practice Address - Street 1:9602 STOCKDALE HWY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311
Practice Address - Country:US
Practice Address - Phone:661-381-7545
Practice Address - Fax:661-381-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0064350Medicaid
CAZZZ37754ZMedicare ID - Type UnspecifiedGROUP MEDICARE #
CAGR0064350Medicaid