Provider Demographics
NPI:1366760548
Name:CORNFORTH, KATHERINE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:CORNFORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 NE LOOP 410 STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1228
Mailing Address - Country:US
Mailing Address - Phone:210-538-8660
Mailing Address - Fax:210-385-8661
Practice Address - Street 1:1007 NE LOOP 410 STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1228
Practice Address - Country:US
Practice Address - Phone:210-538-8660
Practice Address - Fax:210-538-8661
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6233207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217669502Medicaid
TXTXB155893Medicare PIN