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General NPI Number Information
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NPI Number | 1619966520
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Entity Type | Individual
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Provider Name | BRIAN P CORNNELL MD
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Gender | Male
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 1501 PASADENA AVE S
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-3717
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Country | US
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Telephone | 727-381-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14609
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City | CLEARWATER
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State | FL
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Zip | 33766-4609
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Country | US
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Telephone | 727-793-9300
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Fax | 727-712-4688
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME0042908
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License Number State | FL
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