Individual
MR. BRENT CORNISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
613 S MIDWEST BLVD, MIDWEST CITY, OK 73110-4727
(405) 503-0679
Mailing address
613 S MIDWEST BLVD, MIDWEST CITY, OK 73110-4727
(405) 503-0679
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/24/2017
Last updated
07/21/2022
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