Healthcare Provider Details

I. General information

NPI: 1144234774
Provider Name (Legal Business Name): JAMES CORNFIELD D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 MENAUL BLVD NE
ALBUQUERQUE NM
87110-4608
US

IV. Provider business mailing address

8008 MENAUL BLVD NE
ALBUQUERQUE NM
87110-4608
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-5454
  • Fax:
Mailing address:
  • Phone: 505-296-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number128
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: