Provider Demographics
NPI:1720008105
Name:MCCORMICK, WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 EL CAMINO REAL
Mailing Address - Street 2:STE 5
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2860
Mailing Address - Country:US
Mailing Address - Phone:520-458-4335
Mailing Address - Fax:520-452-2232
Practice Address - Street 1:1951 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4606
Practice Address - Country:US
Practice Address - Phone:520-458-0650
Practice Address - Fax:520-459-7030
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1463207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ213447Medicaid
AZ08WCFBL14Medicare PIN
AZE09861Medicare UPIN