Individual
DR. JAN GORDON CORNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1431 WAYNE AVE, DAYTON, OH 45410-1411
(937) 348-7001
(937) 949-6113
Mailing address
PO BOX 746071, ATLANTA, GA 30374-6071
(312) 733-9730
(773) 866-8014
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01070166 A
IN
207Q00000X
Family Medicine Physician
Primary
35.129685
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0067258
—
OH
05
—
201035040
—
IN
Enumeration date
12/15/2006
Last updated
03/18/2024
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