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General NPI Number Information
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NPI Number | 1013993187
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Entity Type | Individual
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Provider Name | DEBRA J MCCORMACK MD
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Gender | Female
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 729 E SPAULDING AVE
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City | PUEBLO WEST
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State | CO
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Zip | 81007-3512
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Country | US
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Telephone | 719-547-9119
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Fax | 719-547-7555
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Provider Business Mailing Address
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Address Line | 729 E SPAULDING AVE
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City | PUEBLO WEST
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State | CO
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Zip | 81007-3512
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Country | US
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Telephone | 719-547-9119
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Fax | 719-547-7555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 27445
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0051488
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License Number State | CO
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