Provider Demographics
NPI:1033209390
Name:MCCOY, ELIZABETH GARCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GARCIA
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:SAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83860-9188
Mailing Address - Country:US
Mailing Address - Phone:661-713-4621
Mailing Address - Fax:
Practice Address - Street 1:1536 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6525
Practice Address - Country:US
Practice Address - Phone:904-475-5800
Practice Address - Fax:904-301-2503
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33714OtherMEDICAL LICENSE
IDM-9616OtherMEDICAL LICENSE
WAMD00046458OtherMEDICAL LICENSE