Provider Demographics
NPI:1417005471
Name:MCCORMICK III, JAMES J (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:MCCORMICK III
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 NW 52ND TERRACE
Mailing Address - Street 2:SUITE #301, ATT: JESSICA BERMUDEZ
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166
Mailing Address - Country:US
Mailing Address - Phone:818-324-9962
Mailing Address - Fax:
Practice Address - Street 1:8350 NW 52ND TERRACE
Practice Address - Street 2:SUITE #301, ATT: JESSICA BERMUDEZ
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166
Practice Address - Country:US
Practice Address - Phone:818-324-9962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 123299207P00000X
CAG080225207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1417005471Medicare NSC
CA1417005471Medicare PIN