Doctor Name: | PAUL MICHAEL MCCOY |
NPI Number: | 1649550518 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 2011025935 |
Business Practice Address: | 3107 Frederick Ave. Orthopedic & Sports Medicine Center St. Joseph, MO - 645062911 |
Business Phone Number: | 8162339888 |
Business Fax Number: | 8162330414 |
Mailing Address: | 3107 Frederick Ave., Orthopedic & Sports Medicine Center ST. JOSEPH |
State: | MO |
Postal Code: | 645062911 |
Phone Number: | 8162339888 |
Fax Number: | 8162330414 |
NPI Enumeration Date: | 08/24/2011 |
NPI Last Update Date: | 08/24/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 2011025935 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |