Doctor Name: | DR. JASON WAYNE MCCORMICK |
NPI Number: | 1306048160 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 4301090001 |
Business Practice Address: | 1040 Sierra Dr Suite 400 Greenwood, IN - 461437240 |
Business Phone Number: | 3175284800 |
Business Fax Number: | |
Mailing Address: | 1000 Oakland Dr, KALAMAZOO |
State: | MI |
Postal Code: | 490081282 |
Phone Number: | 2693374400 |
Fax Number: | |
NPI Enumeration Date: | 06/04/2007 |
NPI Last Update Date: | 10/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 4301090001 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |