Provider Demographics
NPI:1023326469
Name:MCCORKLE, GEOFFREY OSMOND
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:OSMOND
Last Name:MCCORKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2481 SW 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6511
Mailing Address - Country:US
Mailing Address - Phone:305-218-4383
Mailing Address - Fax:
Practice Address - Street 1:2481 SW 102ND AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6511
Practice Address - Country:US
Practice Address - Phone:305-218-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCGC061360171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications