MEDICARE: DR. JOHN RICHARDS MCCORMICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	ME16233	FL

General Provider Information

NPI Number	:	1255543518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RICHARDS MCCORMICK M.D.

Provider Business Mailing Address
First Line	:	224 PONCE DELEON BLVD
Second Line	:
City	:	DE LEON SPRINGS
State	:	FL
Zip	:	32130-3375
Country	:	US
Telephone Number	:	386-822-2801
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 PONCE DELEON BLVD
Second Line	:
City	:	DE LEON SPRINGS
State	:	FL
Zip	:	32130-3375
Country	:	US
Telephone Number	:	386-822-2801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	02/05/2015

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