Provider Demographics
NPI:1992792006
Name:MCCORMICK, DUNCAN S (MD)
Entity type:Individual
Prefix:
First Name:DUNCAN
Middle Name:S
Last Name:MCCORMICK
Suffix:
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:PO BOX 1095
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-1095
Mailing Address - Country:US
Mailing Address - Phone:701-857-7996
Mailing Address - Fax:701-857-7996
Practice Address - Street 1:1 MAIN ST N
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-3189
Practice Address - Country:US
Practice Address - Phone:701-857-7996
Practice Address - Fax:701-857-7996
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5766207K00000X, 207KI0005X, 207RA0201X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Not Answered207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Not Answered2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17845Medicaid
E27478Medicare UPIN
ND17845Medicaid