Individual
DR. ROY BRADFORD CORNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2801 NEW HARTFORD RD, OWENSBORO, KY 42303-1320
(270) 683-3720
(270) 686-7331
Mailing address
2801 NEW HARTFORD RD, OWENSBORO, KY 42303-1320
(270) 683-3720
(270) 686-7331
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01047053A
IN
208600000X
Surgery Physician
Primary
30382
KY
2086S0129X
Vascular Surgery Physician
01047053A
IN
2086S0129X
Vascular Surgery Physician
30382
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000048408
ANTHEM
KY
01
—
020037451
RAILROAD MEDICARE
—
01
—
200139790
MOLINA
IN
05
—
200139790
—
IN
01
—
611059472
UMWA
—
01
—
611059472110
CARESOURCE
IN
05
—
64303829
—
KY
Enumeration date
07/21/2005
Last updated
01/29/2008
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