Individual
KEVIN MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PHD
Contact information
Practice address
2001 WEBBER ST, SARASOTA, FL 34239-5288
(941) 362-8900
(941) 362-8987
Mailing address
2001 WEBBER ST, SARASOTA, FL 34239-5288
(941) 362-8900
(941) 362-8987
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
ME50801
FL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME50801
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10753
BLUE SHIELD
FL
05
—
372523500
—
FL
Enumeration date
08/09/2005
Last updated
02/03/2010
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