Provider Demographics
NPI:1679560379
Name:MCCOY, ROBERT N (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:N
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1800 BUCKNER ST
Mailing Address - Street 2:SUITE C120
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4440
Mailing Address - Country:US
Mailing Address - Phone:318-227-8899
Mailing Address - Fax:318-222-0407
Practice Address - Street 1:1800 BUCKNER ST
Practice Address - Street 2:SUITE C120
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4440
Practice Address - Country:US
Practice Address - Phone:318-227-8899
Practice Address - Fax:318-222-0407
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA05128R207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A007OtherCHAMPUS
721404303MC1OtherOCHSNER
3100064OtherUNITER HEALTHCARE
LA390005505OtherRAILROAD MEDICARE
LA1313548Medicaid
TX053664101OtherTEXAS MEDICAID
LAB63602Medicare UPIN
LA1313548Medicaid