Provider Demographics
NPI:1679792527
Name:CORNIDEZ, ERIC G (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:G
Last Name:CORNIDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4582 N 1ST AVE
Mailing Address - Street 2:STE 170
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-8602
Mailing Address - Country:US
Mailing Address - Phone:520-318-6035
Mailing Address - Fax:520-795-9953
Practice Address - Street 1:4582 N 1ST AVE
Practice Address - Street 2:STE 170
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-8602
Practice Address - Country:US
Practice Address - Phone:520-318-6035
Practice Address - Fax:520-795-9953
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ37595207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ524557Medicaid
AZ524557Medicaid