Individual
JESS M CORNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 N MAGDALEN ST, SAN ANGELO, TX 76903-5400
(325) 658-1511
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
D5941
TX
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
D5941
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136008302
—
TX
Enumeration date
11/08/2005
Last updated
12/22/2015
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