Provider Demographics
NPI:1013506609
Name:CORNEJO, EDUARDO (MD37769)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:CORNEJO
Suffix:
Gender:M
Credentials:MD37769
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4026 OAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-5783
Mailing Address - Country:US
Mailing Address - Phone:954-716-0593
Mailing Address - Fax:
Practice Address - Street 1:4026 OAK FOREST DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-5783
Practice Address - Country:US
Practice Address - Phone:954-716-0593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKMD37769208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice