Provider Demographics
NPI:1326223686
Name:MCCORKLE, RYAN JACKSON (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JACKSON
Last Name:MCCORKLE
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Gender:M
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:500 WINDERLEY PL
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7247
Mailing Address - Country:US
Mailing Address - Phone:407-875-0555
Mailing Address - Fax:407-875-0244
Practice Address - Street 1:500 WINDERLEY PL
Practice Address - Street 2:SUITE 115
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7247
Practice Address - Country:US
Practice Address - Phone:407-875-0555
Practice Address - Fax:407-875-0244
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME101146207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine