Provider Demographics
NPI:1053451757
Name:ROBERT E MCCOY, MD, INC.
Entity Type:Organization
Organization Name:ROBERT E MCCOY, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EMMITT
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-447-3144
Mailing Address - Street 1:1440 N HARBOR BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4127
Mailing Address - Country:US
Mailing Address - Phone:714-447-3144
Mailing Address - Fax:714-447-1944
Practice Address - Street 1:1440 N HARBOR BLVD
Practice Address - Street 2:STE 100
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4127
Practice Address - Country:US
Practice Address - Phone:714-447-3144
Practice Address - Fax:714-447-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43126208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE59495Medicare UPIN
CAW17921Medicare ID - Type UnspecifiedGROUP NUMBER