Provider Demographics
NPI:1114912888
Name:MCCORMICK, LAURIE M (MD, DFAPA)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:M
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MD, DFAPA
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:M
Other - Last Name:MCPEARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2710 NORTH DODGE STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245
Mailing Address - Country:US
Mailing Address - Phone:319-400-1311
Mailing Address - Fax:319-575-6025
Practice Address - Street 1:2710 NORTH DODGE STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245
Practice Address - Country:US
Practice Address - Phone:319-400-1311
Practice Address - Fax:319-575-6025
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1957207Q00000X
IA350452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0298422Medicaid
IA35290OtherWELLMARK BCBS
IA35290OtherWELLMARK BCBS
H92498Medicare UPIN
IAI10323Medicare PIN