Healthcare Provider Details

I. General information

NPI: 1124015193
Provider Name (Legal Business Name): ROBERT P MCCOY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 2060 BOX SONGTAN
APO AP
96278-2060
US

IV. Provider business mailing address

UNIT 2060 BOX SONGTAN
APO AP
96278-2060
US

V. Phone/Fax

Practice location:
  • Phone: 505-784-9245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34-00-7195-M
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02001572A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number02001572A
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: