Provider Demographics
NPI:1417249095
Name:CORMIER, JERRY EUGENE (APT; CRTS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:EUGENE
Last Name:CORMIER
Suffix:
Gender:M
Credentials:APT; CRTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W POLK AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2138
Mailing Address - Country:US
Mailing Address - Phone:956-787-9511
Mailing Address - Fax:
Practice Address - Street 1:1200 W POLK AVE
Practice Address - Street 2:SUITE L
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2138
Practice Address - Country:US
Practice Address - Phone:956-787-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other