Individual
DR. BRIAN P CORNNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 PASADENA AVE S, SOUTH PASADENA, FL 33707-3717
(727) 381-1000
Mailing address
PO BOX 14609, CLEARWATER, FL 33766-4609
(727) 793-9300
(727) 712-4688
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME0042908
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02090
BLUE CROSS OF FLORIDA
FL
05
—
043847200
—
FL
01
—
300017097
RR MEDICARE
FL
Enumeration date
10/14/2005
Last updated
09/17/2012
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