Provider Demographics
NPI:1023146669
Name:MCCOY, RICHARD DAVID
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DAVID
Last Name:MCCOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 176TH LN NW
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-5570
Mailing Address - Country:US
Mailing Address - Phone:763-441-1278
Mailing Address - Fax:763-241-6894
Practice Address - Street 1:8111 176TH LN NW
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-5570
Practice Address - Country:US
Practice Address - Phone:763-441-1278
Practice Address - Fax:763-241-6894
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2186237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4580901OtherMEDICA
MN07275HOOtherWILSON MCSHANE CORP
MN07275HOOtherBLUECROSS BLUESHIELD
MN106942OtherUCARE
MN90568OtherHEALTHPARTNERS
MN4580195OtherMEDICA