Individual
THERON GARRICK MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8200 CONSTANTIN BLVD FL 3, BATON ROUGE, LA 70809-3481
(225) 765-5500
(225) 765-4378
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 526-0011
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
201441
LA
207K00000X
Allergy & Immunology Physician
L5832
TX
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
201441
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1017973
—
LA
Enumeration date
10/10/2006
Last updated
02/05/2021
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