Provider Demographics
NPI:1639295355
Name:MCKOY, CRAIG D (RPAC)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:D
Last Name:MCKOY
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7069 ROSABELLA CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-8468
Mailing Address - Country:US
Mailing Address - Phone:201-966-4868
Mailing Address - Fax:
Practice Address - Street 1:UF COLLEGE OF MEDICINE JACKSONVILLE
Practice Address - Street 2:653-1 WEST 8TH STREET
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209
Practice Address - Country:US
Practice Address - Phone:904-244-7326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0025031363AS0400X
FL9113489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical