Provider Demographics
NPI:1396700563
Name:MCCOY, GERARD JOSEPH
Entity type:Individual
Prefix:MR
First Name:GERARD
Middle Name:JOSEPH
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 1:604 HAMLET DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-5986
Mailing Address - Country:US
Mailing Address - Phone:386-767-5693
Mailing Address - Fax:386-322-1935
Practice Address - Street 1:604 HAMLET DR
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-5986
Practice Address - Country:US
Practice Address - Phone:386-767-5693
Practice Address - Fax:386-322-1935
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other