Provider Demographics
NPI:1407069248
Name:MCCORMICK, TIMOTHY JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:12443 SAN JOSE BOULEVARD
Mailing Address - Street 2:SUITE 704
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223
Mailing Address - Country:US
Mailing Address - Phone:904-288-8888
Mailing Address - Fax:904-288-8331
Practice Address - Street 1:12443 SAN JOSE BOULEVARD
Practice Address - Street 2:SUITE 704
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-288-8886
Practice Address - Fax:904-288-8331
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
NE1602083X0100X
NM84-2482083X0100X
NMA-794-842083X0100X
FLOS61962083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine