Individual
THOMAS JOSEPH CORNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14679 MIDWAY RD STE 206, ADDISON, TX 75001-3197
(469) 317-9900
(972) 216-7346
Mailing address
PO BOX 740608, DALLAS, TX 75374-0608
(469) 317-9900
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G0384
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122597103
—
TX
01
—
88R744
BCBS
TX
01
—
B006
CHAMPUS
TX
Enumeration date
10/28/2005
Last updated
02/05/2021
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