| Marcus Cornwall, Dopc | |
|
6542 Se Lake Rd Ste 202 Milwaukie OR 97222-2245 | |
| (503) 233-5273 | |
| (855) 492-8902 |
| Full Name | Marcus Cornwall, Dopc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6542 Se Lake Rd Ste 202, Milwaukie, Oregon |
| Authorized Official Name and Position | Marcus H Cornwall (PHYSICIAN AND OWNER) |
| Authorized Official Contact | 5032335273 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marcus Cornwall, Dopc 6542 Se Lake Rd Ste 202 Milwaukie OR 97222-2245 Ph: (503) 233-5273 | Marcus Cornwall, Dopc 6542 Se Lake Rd Ste 202 Milwaukie OR 97222-2245 Ph: (503) 233-5273 |
| NPI Number | 1154514446 |
|---|---|
| Provider Enumeration Date | 08/21/2007 |
| Last Update Date | 12/07/2023 |
| Medicare PECOS PAC ID | 6103857693 |
|---|---|
| Medicare Enrollment ID | O20050824000729 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154514446 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | DO23052 (Oregon) | Primary |
| Provider Name | Marcus H Cornwall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689639841 PECOS PAC ID: 0840283701 Enrollment ID: I20040406001157 |
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