Healthcare Provider Details

I. General information

NPI: 1336453372
Provider Name (Legal Business Name): DR. MAURICE DARRYL MCCORMICK SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 E. 10TH ST.
JEFFERSONVILLE IN
47130
US

IV. Provider business mailing address

2420 E. 10TH
JEFFERSONVILLE IN
47130
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-8248
  • Fax: 812-206-8289
Mailing address:
  • Phone: 812-282-8248
  • Fax: 812-206-8285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: