Provider Demographics
NPI:1508912403
Name:MCCOY, JUSTIN L (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:L
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 NW 56TH
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OKLA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4426
Mailing Address - Country:US
Mailing Address - Phone:405-945-4710
Mailing Address - Fax:405-562-9242
Practice Address - Street 1:3330 NW 56TH
Practice Address - Street 2:SUITE 206
Practice Address - City:OKLA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4426
Practice Address - Country:US
Practice Address - Phone:405-945-4710
Practice Address - Fax:405-562-9242
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23976207P00000X, 2085R0202X
ARE-153512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00964010OtherMEDICARE RAILROAD
OK200116330AMedicaid
OKP00964010OtherMEDICARE RAILROAD