Basic Information
| Provider Information | |||||||||
| NPI: | 1720467707 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORNING | ||||||||
| FirstName: | EVAN | ||||||||
| MiddleName: | DONALD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 RAYNOLDS ST # 51015 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799051613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152154480 | ||||||||
| FaxNumber: | 9152155386 | ||||||||
| Practice Location | |||||||||
| Address1: | 4801 ALBERTA AVE | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799052707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152155400 | ||||||||
| FaxNumber: | 9152158632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2015 | ||||||||
| LastUpdateDate: | 07/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 19891 | NV | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | A168443 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 31487 | OK | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | A168443 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | 19891 | NV | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | T0189 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | T0189 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.