Individual
MARK O. MCCORKINDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
615 E 14TH ST, WAYNE, NE 68787-1152
(402) 375-2500
(402) 375-2463
Mailing address
PO BOX 328, SIOUX CITY, IA 51102-0328
(712) 279-5830
(712) 279-5883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19231
NE
207Q00000X
Family Medicine Physician
29362
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17827
WELLMARK BCBS - MAPLE VAL
IA
05
—
7085498
—
NE
05
—
8085498
—
IA
Enumeration date
05/24/2006
Last updated
10/17/2007
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