Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 27286 | IA |
NPI | 1003877184 |
---|---|
Provider Name | Michael J Mccoy |
First Address | West Burlington, IA 52655-1682 |
Second Address | West Burlington, IA 52655-1682 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 06/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003877184 | (05) | IA |
1003877184 | WELLMARK (01) | IA |
E33516 | (02) | IA |
P00876850 | RAILROAD MEDICARE (01) | IA |