Provider Demographics
NPI:1962457903
Name:CORN, WILLIAM ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:CORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7464
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94120-7464
Mailing Address - Country:US
Mailing Address - Phone:415-206-3103
Mailing Address - Fax:415-206-3872
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:RM 4M62
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-4353
Practice Address - Fax:415-476-5582
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68193207T00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G681930Medicaid
F67976Medicare UPIN
CA00G681930Medicare ID - Type Unspecified