Basic Information
| Provider Information | |||||||||
| NPI: | 1124015193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCOY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 W LOSEY ST | ||||||||
| Address2: | |||||||||
| City: | SCOTT AFB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622255250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182569355 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 690 BARNES BLVD | ||||||||
| Address2: | |||||||||
| City: | JOINT BASE LEWIS MCCHORD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984381303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404544394 | ||||||||
| FaxNumber: | 2539820158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 02001572A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 34-00-7195-M | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 2083A0100X | 02001572A | IL | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine |
No ID Information.