Provider Demographics
NPI:1508177064
Name:MCCOY MALOSKEY, TRACY L (DO)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:MCCOY MALOSKEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1050 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2905
Mailing Address - Country:US
Mailing Address - Phone:573-364-9000
Mailing Address - Fax:573-458-3952
Practice Address - Street 1:1060 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2905
Practice Address - Country:US
Practice Address - Phone:573-426-2860
Practice Address - Fax:573-202-2405
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015021208600000X
MO2020027287208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery