Provider Demographics
NPI:1245200039
Name:MCCOY, GARY S (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:MCCOY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9765 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-4402
Mailing Address - Country:US
Mailing Address - Phone:904-262-7087
Mailing Address - Fax:904-262-7215
Practice Address - Street 1:9765 SAN JOSE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-4402
Practice Address - Country:US
Practice Address - Phone:904-262-7087
Practice Address - Fax:904-262-7215
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1996213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-3516897OtherTAX ID
FL040679100Medicaid
FL480030592OtherRAILROAD MEDICARE
FLT96229Medicare UPIN
FL4133400001Medicare NSC
FL59-3516897OtherTAX ID
T96229Medicare UPIN