Provider Demographics
NPI:1033506720
Name:MCCORMICK, BENJAMIN JAMES
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JAMES
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 PHYSICIANS OFFICE BUILDING
Mailing Address - Street 2:170 MANNING DRIVE, CB 7235
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7235
Mailing Address - Country:US
Mailing Address - Phone:919-834-9014
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-7235
Practice Address - Country:US
Practice Address - Phone:801-213-2704
Practice Address - Fax:801-585-2891
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11781995-1205208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology