Provider Demographics
NPI:1689626343
Name:KOOY, NEIL W (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:W
Last Name:KOOY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:408 N STATE OF FRANKLIN RD
Mailing Address - Street 2:SUITE 31D
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6089
Mailing Address - Country:US
Mailing Address - Phone:423-431-4946
Mailing Address - Fax:423-431-4947
Practice Address - Street 1:408 N STATE OF FRANKLIN RD
Practice Address - Street 2:SUITE 31D
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6089
Practice Address - Country:US
Practice Address - Phone:423-431-4946
Practice Address - Fax:423-431-4947
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-02-15
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Provider Licenses
StateLicense IDTaxonomies
TN207132080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1689626343Medicaid
TNQ015096Medicaid
TNQ015096Medicaid