Provider Demographics
NPI:1124077342
Name:MCCORKLE, ALLAN JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:JAMES
Last Name:MCCORKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7021 KEWANEE AVE
Mailing Address - Street 2:6-104
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-7050
Mailing Address - Country:US
Mailing Address - Phone:888-622-6755
Mailing Address - Fax:866-622-6755
Practice Address - Street 1:7021 KEWANEE AVE
Practice Address - Street 2:6-104
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-7050
Practice Address - Country:US
Practice Address - Phone:888-622-6755
Practice Address - Fax:866-622-6755
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJO11O2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1477271929OtherGROUP NPI
TX123652303Medicaid
TXE95906Medicare UPIN
TX123652303Medicaid