Provider Demographics
NPI:1326034042
Name:MCCOY, ROBERT H (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
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 1:7315 212TH ST SW
Mailing Address - Street 2:SUITE 208
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7610
Mailing Address - Country:US
Mailing Address - Phone:425-791-3084
Mailing Address - Fax:425-791-3086
Practice Address - Street 1:7315 212TH ST SW
Practice Address - Street 2:SUITE 208
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7610
Practice Address - Country:US
Practice Address - Phone:425-791-3084
Practice Address - Fax:425-791-3086
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2013-02-12
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
WAMD00024570174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAB18309Medicare UPIN