Individual
RAYMOND L CORNELISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2222 W IOWA AVE, CHICKASHA, OK 73018-2738
(405) 224-8111
(405) 594-0708
Mailing address
2222 W IOWA AVE, CHICKASHA, OK 73018-2738
(405) 224-8111
(405) 594-0708
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
9074
OK
207ND0900X
Dermatopathology Physician
9074
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528364304
GROUP NPI
OK
Enumeration date
03/11/2006
Last updated
11/04/2025
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