Provider Demographics
NPI:1932160900
Name:MCCOY, CRAIG WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WILLIAM
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 FORT MISSOULA ROAD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7403
Mailing Address - Country:US
Mailing Address - Phone:406-728-8170
Mailing Address - Fax:406-728-9409
Practice Address - Street 1:2825 FORT MISSOULA ROAD
Practice Address - Street 2:SUITE 217
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7403
Practice Address - Country:US
Practice Address - Phone:406-728-8170
Practice Address - Fax:406-728-9409
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
81086208059804A003OtherTRICARE
MT000011920OtherBCBS
MT0042965Medicaid
MT000011920OtherBCBS
81086208059804A003OtherTRICARE