Provider Demographics
NPI:1659532869
Name:CORNELL, DEBORAH G
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:G
Last Name:CORNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:GAIL
Other - Last Name:KLEIMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:18209 53RD STREET CT E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8955
Mailing Address - Country:US
Mailing Address - Phone:804-249-2719
Mailing Address - Fax:
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:MS 01 27 DEPT OF EM
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-426-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60331128207P00000X
390200000X
IL036.127237207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program