Individual
MR. COLE ALAN MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
12266 DEPAUL DRIVE SUITE 205, BRIDGETON, MO 63044
(314) 218-2300
Mailing address
660 S EUCLID AVE, CB 8052, SAINT LOUIS, MO 63110-1010
(314) 454-8917
(314) 747-2200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2019040259
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220080576
—
MO
Enumeration date
10/11/2016
Last updated
12/12/2023
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