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General NPI Number Information
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NPI Number | 1811917628
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Entity Type | Organization
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Legal Business Name | MICHAEL H MCCORMICK M D P A
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 2202 STATE AVE SUITE 300
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City | PANAMA CITY
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State | FL
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Zip | 32405-7601
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Country | US
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Telephone | 850-769-2417
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Fax | 850-784-1144
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Provider Business Mailing Address
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Address Line | 2202 STATE AVE SUITE 300
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City | PANAMA CITY
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State | FL
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Zip | 32405-7601
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Country | US
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Telephone | 850-769-2417
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Fax | 850-784-1144
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Authorized Official
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Title or Position | MEDICAL ASSISTANT
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Name | MRS. DORIS B. KELLEY
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Credential |
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Telephone | 850-769-2417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME0051595
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME104621
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License Number State | FL
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