Individual
JAYNE MARIE MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8300 CONSTITUTION AVE NE, KASEMAN HOSPICE, ALBUQUERQUE, NM 87110-7613
(505) 559-1000
(505) 559-7015
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD2011-0692
NM
2086H0002X
Hospice and Palliative Medicine (Surgery) Physician
Primary
MD2011-0692
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699730663
GROUP NPI
NE
05
—
47084573713
—
NE
Enumeration date
01/18/2007
Last updated
01/22/2016
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