MEDICARE: DR. ROBERT ALEXANDER MCCORMICK 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	207Q00000X	Family Medicine Physician	69-164	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922113349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ALEXANDER MCCORMICK MD

Provider Business Mailing Address
First Line	:	11 CALLE MEDICO
Second Line	:	SUITE 2
City	:	SANTA FE
State	:	NM
Zip	:	87505-4705
Country	:	US
Telephone Number	:	505-983-1003
Fax Number	:	505-983-1008

Provider Business Practice Location Address
First Line	:	11 CALLE MEDICO
Second Line	:	SUITE 2
City	:	SANTA FE
State	:	NM
Zip	:	87505-4705
Country	:	US
Telephone Number	:	505-983-1003
Fax Number	:	505-983-1008

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	02/01/2008

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