Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 37787 | SC |
NPI | 1174676001 |
---|---|
Provider Name | Dr. Travis Wyatt Mccoy |
First Address | Greenville, SC 29615-3170 |
Second Address | Greenville, SC 29615-3170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 09/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000000522575 | ANTHEM (01) | KY |
000000522532 | ANTHEM (01) | KY |
200866890 | (05) | IN |
50015433 | PASSPORT PCP (01) | KY |
50015434 | PASSPORT SPECIALITY (01) | KY |
50015435 | PASSPORT SPECIALITY (01) | KY |
7100012890 | (05) | KY |