Provider Demographics
NPI:1073659306
Name:MCCORMICK, TIMOTHY CHAD (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHAD
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-0001
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015223207V00000X
PAOT013710207VX0201X
TXP6032207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2516221OtherHIGHMARK BLUE SHIELD-WMG
PA1024859880001Medicaid
PA307945OtherUNISON-WMG
PA30077866OtherAMERIHEALTH MERCY-WMG
PA1590832OtherGATEWAY-WMG
PA415272OtherUMPC-WMG
PA968832OtherCAREFIRST MD BCBS-WMG
PA1590832OtherGATEWAY-WMG
PAP00883462Medicare PIN