Provider Demographics
NPI:1760666267
Name:ROBERT A MCCORMICK MD LTD
Entity Type:Organization
Organization Name:ROBERT A MCCORMICK MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-983-1003
Mailing Address - Street 1:11 CALLE MEDICO
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4705
Mailing Address - Country:US
Mailing Address - Phone:505-983-1003
Mailing Address - Fax:505-983-1008
Practice Address - Street 1:11 CALLE MEDICO
Practice Address - Street 2:SUITE 2
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4705
Practice Address - Country:US
Practice Address - Phone:505-983-1003
Practice Address - Fax:505-983-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM69164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty