Provider Demographics
NPI:1366547994
Name:BRITT, CORNELIUS L (MD)
Entity type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:L
Last Name:BRITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94220 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-7756
Mailing Address - Country:US
Mailing Address - Phone:541-247-3000
Mailing Address - Fax:541-247-3104
Practice Address - Street 1:94220 4TH ST
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444-7756
Practice Address - Country:US
Practice Address - Phone:541-247-3910
Practice Address - Fax:541-247-3109
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD179516207X00000X
WY6789A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR119263OtherCURRY HEALTH DISTRICT MEDICAID
OR1487696985OtherCURRY HEALTH DISTRICT NPI
OR930937095OtherCURRY HEALTH DISTRICT TAX I.D.
ORR0000ZGBDGOtherCURRY HEALTH DISTRICT MEDICARE
OR500717826Medicaid
WY0241980001Medicare NSC
WY200046183Medicare PIN
A10337Medicare UPIN
OR500717826Medicaid