Provider Demographics
NPI:1437289782
Name:MCCOY, MARY BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12033 AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-7718
Mailing Address - Country:US
Mailing Address - Phone:928-669-2137
Mailing Address - Fax:928-669-3222
Practice Address - Street 1:12033 AGENCY RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-7718
Practice Address - Country:US
Practice Address - Phone:928-669-2137
Practice Address - Fax:928-669-3222
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMO 103425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ418857Medicaid
F93902Medicare UPIN