Provider Demographics
NPI:1376893560
Name:ELDRIDGE E MCCORMICK MD PA
Entity Type:Organization
Organization Name:ELDRIDGE E MCCORMICK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELDRIDGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-792-9125
Mailing Address - Street 1:2109 60TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5526
Mailing Address - Country:US
Mailing Address - Phone:941-798-9184
Mailing Address - Fax:
Practice Address - Street 1:2109 60TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5526
Practice Address - Country:US
Practice Address - Phone:941-792-9125
Practice Address - Fax:941-798-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58221Medicare UPIN
FL71877Medicare PIN