Basic Information
| Provider Information | |||||||||
| NPI: | 1952482846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCORMICK | ||||||||
| FirstName: | BETSY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5245 E FLETCHER AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336171126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139147314 | ||||||||
| FaxNumber: | 8136768812 | ||||||||
| Practice Location | |||||||||
| Address1: | 5245 E FLETCHER AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336171126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139147314 | ||||||||
| FaxNumber: | 8136768812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 04/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VE0102X | ME101376 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 2572032 | 05 | OH | MEDICAID |