Provider Demographics
NPI:1750395760
Name:MCCORMICK, MARK B (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
Last Name:MCCORMICK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1050 NW 15TH ST
Mailing Address - Street 2:#215A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1375
Mailing Address - Country:US
Mailing Address - Phone:561-395-7704
Mailing Address - Fax:561-392-8103
Practice Address - Street 1:1050 NW 15TH ST
Practice Address - Street 2:#215A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1375
Practice Address - Country:US
Practice Address - Phone:561-395-7704
Practice Address - Fax:561-392-8103
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-04-27
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Provider Licenses
StateLicense IDTaxonomies
FLME0043652207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63205Medicare UPIN