MEDICARE: CLINT M CORMIER MD

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	207V00000X	Obstetrics & Gynecology Physician	024745	LA
2	207V00000X	Obstetrics & Gynecology Physician	M6087	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8F9683	OTHER	TX	BCBSTX
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861496770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINT M CORMIER MD

Provider Business Mailing Address
First Line	:	2508 BERT KOUNS INDUSTRIAL LOOP STE 210
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3175
Country	:	US
Telephone Number	:	318-212-5860
Fax Number	:	318-212-5865

Provider Business Practice Location Address
First Line	:	2508 BERT KOUNS INDUSTRIAL LOOP STE 210
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3175
Country	:	US
Telephone Number	:	318-212-5860
Fax Number	:	318-212-5865

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	06/23/2021

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Directions to “ CLINT M CORMIER MD” Practice Location

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