Doctor Name: | DR. TALBOT GREEN MCCORMICK |
NPI Number: | 1114240223 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 60-17 |
Business Practice Address: | 2306 Cologne Dr. Granbury, TX - 76048 |
Business Phone Number: | 8175798285 |
Business Fax Number: | 8175798285 |
Mailing Address: | 2306 Cologne Dr., GRANBURY |
State: | TX |
Postal Code: | 76048 |
Phone Number: | 8175798285 |
Fax Number: | 8175798285 |
NPI Enumeration Date: | 03/03/2010 |
NPI Last Update Date: | 03/03/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 60-17 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |