MEDICARE: DR. DAVID JAMES CORNISH DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	10399	WV

General Provider Information

NPI Number	:	1114112042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JAMES CORNISH DPM

Provider Business Mailing Address
First Line	:	314 GOFF MOUNTAIN RD
Second Line	:	SUITE #1
City	:	CROSS LANES
State	:	WV
Zip	:	25313-6602
Country	:	US
Telephone Number	:	304-776-7990
Fax Number	:	304-776-7974

Provider Business Practice Location Address
First Line	:	314 GOFF MOUNTAIN RD
Second Line	:	SUITE #1
City	:	CROSS LANES
State	:	WV
Zip	:	25313-6602
Country	:	US
Telephone Number	:	304-776-7990
Fax Number	:	304-776-7974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/13/2007

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