Doctor Name: | GEOFFREY OSMOND MCCORKLE |
NPI Number: | 1023326469 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | CGC061360 |
Business Practice Address: | 2481 Sw 102nd Ave Miramar, FL - 330256511 |
Business Phone Number: | 3052184383 |
Business Fax Number: | |
Mailing Address: | 2481 Sw 102nd Ave, MIRAMAR |
State: | FL |
Postal Code: | 330256511 |
Phone Number: | 3052184383 |
Fax Number: | |
NPI Enumeration Date: | 09/20/2010 |
NPI Last Update Date: | 09/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171WH0202X |
License Number: | CGC061360 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Contractor |
Taxonomy Specialization: | Home Modifications |
Taxonomy Definition: |