Basic Information
| Provider Information | |||||||||
| NPI: | 1669851903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCOY | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5106 ALLEGANY DR | ||||||||
| Address2: | |||||||||
| City: | KILLEEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765495713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303101831 | ||||||||
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| Practice Location | |||||||||
| Address1: | 36000 DARNALL LOOP | ||||||||
| Address2: | ATTN: MCXI-DEM | ||||||||
| City: | KILLEEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765445095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542888303 | ||||||||
| FaxNumber: | 2542888336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2015 | ||||||||
| LastUpdateDate: | 11/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | 390200000X | TX | N | Hospitals | Military Hospital | 207P00000X | 2018-02287 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.