Provider Demographics
NPI:1093774093
Name:MCCOY, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 501123
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-0001
Mailing Address - Country:US
Mailing Address - Phone:615-846-1625
Mailing Address - Fax:615-846-1630
Practice Address - Street 1:397 WALLACE RD
Practice Address - Street 2:SUITE C-314
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4854
Practice Address - Country:US
Practice Address - Phone:615-846-1625
Practice Address - Fax:615-846-1630
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN20623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30524821Medicaid
TN4224456OtherAETNA
TN4171503OtherBLUE CROSS BLUE SHIELD
TN4224456OtherAETNA
TN30524821Medicaid