Provider Demographics
NPI:1952323008
Name:CORNETT, JACOB ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ANDREW
Last Name:CORNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:ONE HOAG DRIVE
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4162
Mailing Address - Country:US
Mailing Address - Phone:949-764-6954
Mailing Address - Fax:949-764-5674
Practice Address - Street 1:ONE HOAG DRIVE
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-6954
Practice Address - Fax:949-764-5674
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA74213207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A742130385OtherCALOPTIMA ID #
CA00A742130OtherBLUE SHIELD ID #
CA00A742130Medicaid
CA00A742130385OtherCALOPTIMA ID #
CAI03924Medicare UPIN