Provider Demographics
NPI:1952360711
Name:CORNATZER, WILLIAM EUGENE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EUGENE
Last Name:CORNATZER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:225 N 7TH ST # 2
Mailing Address - Street 2:UNITED BANK BLDG
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4417
Mailing Address - Country:US
Mailing Address - Phone:701-224-1273
Mailing Address - Fax:701-323-2929
Practice Address - Street 1:225 N 7TH ST # 2
Practice Address - Street 2:UNITED BANK BLDG
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4417
Practice Address - Country:US
Practice Address - Phone:701-224-1273
Practice Address - Fax:701-323-2929
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND5189207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15003Medicaid
ND1343OtherBLUE CROSS & BLUE SHIELD
ND1343OtherBLUE CROSS & BLUE SHIELD
D25812Medicare UPIN