Cornell, Jan Gordon

Cornell, Jan Gordon is an individual health care provider with primary practice located at 1431 Wayne Ave , Dayton OH 45410-1411. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Cornell, Jan Gordon can be contacted via phone (937) 348-7001.

Contact Information

Primary practice address
1431 Wayne Ave Dayton OH 45410-1411
Phone: (937) 348-7001
Fax: (937) 949-6113
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01070166 A Indiana
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 35.129685 Ohio

Profile Details

NPI number 1306908132
LBN Legal business name Cornell, Jan Gordon
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 15th, 2006
Last updated Mar 18th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306908132 NPPES
Indiana MEDICAID 201035040
Indiana MEDICAID 0067258

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