Provider Demographics
NPI:1669884987
Name:CORNWELL, JAMES NELSON (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:NELSON
Last Name:CORNWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:514 PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-7915
Mailing Address - Country:US
Mailing Address - Phone:918-215-5100
Mailing Address - Fax:918-215-5105
Practice Address - Street 1:514 PLAZA CT
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063
Practice Address - Country:US
Practice Address - Phone:918-215-5100
Practice Address - Fax:918-215-5105
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6310207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK675798OtherMEDICARE
OK200769410AMedicaid