Provider Demographics
NPI:1518956507
Name:MCCORMICK, LINDA JEAN (DO)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JEAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:100 NW MOCK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2500
Mailing Address - Country:US
Mailing Address - Phone:816-228-1000
Mailing Address - Fax:816-463-6035
Practice Address - Street 1:100 NW MOCK AVE STE 200
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2500
Practice Address - Country:US
Practice Address - Phone:816-228-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3D26207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14059097OtherBCBS OF KANSAS CITY
MO14059097OtherBCBS OF KANSAS CITY