Provider Demographics
NPI:1255543518
Name:MCCORMICK, JOHN RICHARDS (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARDS
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:224 PONCE DELEON BLVD
Mailing Address - Street 2:
Mailing Address - City:DE LEON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32130-3375
Mailing Address - Country:US
Mailing Address - Phone:386-822-2801
Mailing Address - Fax:
Practice Address - Street 1:224 PONCE DELEON BLVD
Practice Address - Street 2:
Practice Address - City:DE LEON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32130-3375
Practice Address - Country:US
Practice Address - Phone:386-822-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD66037Medicare UPIN