Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A068844 | CA |
NPI | 1235215302 |
---|---|
Provider Name | Michael Jude Mccormick |
First Address | Grass Valley, CA 95945-5082 |
Second Address | Grass Valley, CA 95945-5082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 14/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GR0100570 | (05) | CA |
GR0100571 | (05) | CA |
H41654 | (02) | CA |