Individual
KATHLEEN ANN MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 NW 12TH AVE, SUITE 107, BATTLE GROUND, WA 98604-9141
(360) 687-6650
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
15379
AZ
207Q00000X
Family Medicine Physician
Primary
MD60125725
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
265761
—
AZ
05
—
500635744
—
OR
01
—
P01039121
RR MEDICARE - PH&S
WA
Enumeration date
04/17/2006
Last updated
02/08/2013
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