Provider Demographics
NPI:1124323837
Name:MCCORMACK, DANIEL RAY JR (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:RAY
Last Name:MCCORMACK
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2845 FARRELL CRESCENT
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:270-926-3297
Mailing Address - Fax:270-926-7325
Practice Address - Street 1:2845 FARRELL CRESCENT
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:270-926-3297
Practice Address - Fax:270-926-7325
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY03727207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology