Individual
MOLLY M MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
708 E WYTHE CREEK CT STE 103, KUNA, ID 83634-5005
(208) 922-5130
(208) 375-2217
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MRO-1478
ID
207Q00000X
Family Medicine Physician
Primary
O-1008
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003296724
—
ID
Enumeration date
06/08/2015
Last updated
12/15/2023
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