Provider Demographics
NPI:1417286121
Name:MCCOY, SIMON J (DPM)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:J
Last Name:MCCOY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:S.
Other - Middle Name:JAMES
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:HARBOR BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:48441-0282
Mailing Address - Country:US
Mailing Address - Phone:810-535-5507
Mailing Address - Fax:810-535-5578
Practice Address - Street 1:219 STATE ST
Practice Address - Street 2:
Practice Address - City:HARBOR BEACH
Practice Address - State:MI
Practice Address - Zip Code:48441-1206
Practice Address - Country:US
Practice Address - Phone:810-535-5507
Practice Address - Fax:810-535-5578
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002343213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery