Individual
JUAN A CORNEJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4303 LIVE OAK DRIVE, LITTLE RIVER, SC 29566
(843) 663-8000
Mailing address
PO BOX 547, LITTLE RIVER, SC 29566
(843) 663-8000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
7783
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007838
—
SC
Enumeration date
05/18/2006
Last updated
03/26/2015
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