Provider Demographics
NPI:1518961911
Name:MCCOY, ROBERT EMMITT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EMMITT
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 1:1950 SUNNY CREST DR STE 2600
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1950 SUNNYCREST DR
Practice Address - Street 2:STE 2600
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3638
Practice Address - Country:US
Practice Address - Phone:714-446-5260
Practice Address - Fax:714-446-5265
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43126208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE59495Medicare UPIN
CAWA43126GMedicare PIN