Individual
DR. CASEY RYAN CORNELIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2525 NE 139TH ST, VANCOUVER, WA 98686-2719
(360) 882-2778
(360) 604-1697
Mailing address
700 NE 87TH AVE, VANCOUVER, WA 98664-1913
(360) 882-2778
(360) 604-1697
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
OP60094538
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8548281
—
WA
Enumeration date
04/20/2007
Last updated
10/08/2010
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