Healthcare Provider Details

I. General information

NPI: 1548225865
Provider Name (Legal Business Name): CATHERINE M MCCORMICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52579 HIGHWAY 51 S
INDEPENDENCE LA
70443-2231
US

IV. Provider business mailing address

52579 HIGHWAY 51 S
INDEPENDENCE LA
70443-2231
US

V. Phone/Fax

Practice location:
  • Phone: 985-878-1349
  • Fax: 985-878-1630
Mailing address:
  • Phone: 985-878-1349
  • Fax: 985-878-1630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number018264
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: