Provider Demographics
NPI:1417275348
Name:O'COYNE, NICKEY R JR (MD)
Entity Type:Individual
Prefix:
First Name:NICKEY
Middle Name:R
Last Name:O'COYNE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-8600
Mailing Address - Fax:623-876-6992
Practice Address - Street 1:13640 N PLAZA DEL RIO BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4846
Practice Address - Country:US
Practice Address - Phone:623-876-8600
Practice Address - Fax:623-876-6992
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ44435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine