Provider Demographics
NPI:1174676001
Name:MCCOY, TRAVIS WYATT (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:WYATT
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CALEDON CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3170
Mailing Address - Country:US
Mailing Address - Phone:864-232-7734
Mailing Address - Fax:864-232-7099
Practice Address - Street 1:17 CALEDON CT
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3170
Practice Address - Country:US
Practice Address - Phone:864-232-7734
Practice Address - Fax:864-232-7099
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37787207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0000000522575OtherANTHEM
KY000000522532OtherANTHEM
KY50015434OtherPASSPORT SPECIALITY
KY50015433OtherPASSPORT PCP
IN200866890Medicaid
KY50015435OtherPASSPORT SPECIALITY
KY7100012890Medicaid
KY0722534Medicare PIN
KY7100012890Medicaid