Provider Demographics
NPI:1255577953
Name:WILLIAM J MCCORMACK MD PA
Entity type:Organization
Organization Name:WILLIAM J MCCORMACK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-567-6181
Mailing Address - Street 1:275 18TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0824
Mailing Address - Country:US
Mailing Address - Phone:772-567-6181
Mailing Address - Fax:772-567-8242
Practice Address - Street 1:275 18TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0824
Practice Address - Country:US
Practice Address - Phone:772-567-6181
Practice Address - Fax:772-567-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059271207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty