Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH3505 | FL |
NPI | 1194705582 |
---|---|
Provider Name | Dr. Bruce Mccoy |
First Address | Margate, FL 33068-5703 |
Second Address | Margate, FL 33068-5703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U51172 | (02) | FL |