Provider Demographics
NPI:1417514613
Name:BRUCE M. MCCORMACK, MD., INC
Entity Type:Organization
Organization Name:BRUCE M. MCCORMACK, MD., INC
Other - Org Name:BRUCE M. MCCORMACK, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-923-9222
Mailing Address - Street 1:2320 SUTTER ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3023
Mailing Address - Country:US
Mailing Address - Phone:415-923-9222
Mailing Address - Fax:415-923-9255
Practice Address - Street 1:2320 SUTTER ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3023
Practice Address - Country:US
Practice Address - Phone:415-923-9222
Practice Address - Fax:415-923-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0661131Medicaid