Provider Demographics
NPI:1336106293
Name:MCCOY, ANGELA MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MICHELE
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4625 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3831
Mailing Address - Country:US
Mailing Address - Phone:405-632-2323
Mailing Address - Fax:405-631-9315
Practice Address - Street 1:4625 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3831
Practice Address - Country:US
Practice Address - Phone:405-632-2323
Practice Address - Fax:405-631-9315
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK217832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200028350AMedicaid
I06951Medicare UPIN
OK241418808Medicare PIN