Individual
DR. CHARLES ROBERT MCCORMICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1240 W ROBINHOOD DR, SUITE G, STOCKTON, CA 95207-5507
(209) 472-1470
(209) 472-1961
Mailing address
1240 W ROBINHOOD DR, SUITE G, STOCKTON, CA 95207-5507
(209) 472-1470
(209) 472-1961
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G35177
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
721556520
TAX ID
CA
01
—
G35177
STATE LICENSE
CA
Enumeration date
06/26/2006
Last updated
03/07/2023
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