Provider Demographics
NPI:1588641369
Name:CORNUM, KORY (MD)
Entity Type:Individual
Prefix:DR
First Name:KORY
Middle Name:
Last Name:CORNUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:127 GLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:LANGLEY AFB
Mailing Address - State:VA
Mailing Address - Zip Code:23665-1906
Mailing Address - Country:US
Mailing Address - Phone:757-876-9190
Mailing Address - Fax:757-764-6843
Practice Address - Street 1:45 PINE ST
Practice Address - Street 2:1ST MEDICAL GROUP
Practice Address - City:LANGLEY AFB
Practice Address - State:VA
Practice Address - Zip Code:23665-2025
Practice Address - Country:US
Practice Address - Phone:757-764-6969
Practice Address - Fax:757-764-6843
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL14036207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery