Provider Demographics
NPI:1750439188
Name:MCCOY, BRUCE PHILLIP (MD)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:PHILLIP
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:526 NORTH ELAM AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1132
Mailing Address - Country:US
Mailing Address - Phone:336-855-6131
Mailing Address - Fax:336-855-6132
Practice Address - Street 1:526 NORTH ELAM AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1132
Practice Address - Country:US
Practice Address - Phone:336-855-6131
Practice Address - Fax:336-855-6132
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC24271207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7393398OtherAETNA
NC4431617002OtherCIGNA
NC55821OtherBCBS
NC8955821Medicaid
C81614Medicare UPIN
NC8955821Medicaid