Provider Demographics
NPI:1699797498
Name:MCCORMICK, LOUIS H III (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:H
Last Name:MCCORMICK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 HAIFLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-3731
Mailing Address - Country:US
Mailing Address - Phone:337-828-4440
Mailing Address - Fax:
Practice Address - Street 1:606 HAIFLEIGH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-3731
Practice Address - Country:US
Practice Address - Phone:337-828-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.04661R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1197068Medicaid
LA1197068Medicaid
5K484Medicare ID - Type Unspecified