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General NPI Number Information
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NPI Number | 1538165139
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Entity Type | Individual
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Provider Name | CHAD D MCCORMICK MD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 849 N SYRINGA ST
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City | POST FALLS
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State | ID
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Zip | 83854-8794
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Country | US
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Telephone | 208-777-1320
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Fax | 208-777-1322
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Provider Business Mailing Address
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Address Line | 849 N SYRINGA ST
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City | POST FALLS
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State | ID
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Zip | 83854-8794
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Country | US
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Telephone | 208-777-1320
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Fax | 208-777-1322
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | M9014
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License Number State | ID
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