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General NPI Number Information
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NPI Number | 1255577953
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Entity Type | Organization
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Legal Business Name | WILLIAM J MCCORMACK MD PA
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Dates
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Enumeration Date | 12/30/2008
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 275 18TH ST SUITE 103
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City | VERO BEACH
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State | FL
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Zip | 32960-0824
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Country | US
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Telephone | 772-567-6181
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Fax | 772-567-8242
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Provider Business Mailing Address
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Address Line | 275 18TH ST SUITE 103
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City | VERO BEACH
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State | FL
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Zip | 32960-0824
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Country | US
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Telephone | 772-567-6181
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Fax | 772-567-8242
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | HEATHER KLINE
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Credential |
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Telephone | 772-567-6181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME0059271
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License Number State | FL
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