Healthcare Provider Details

I. General information

NPI: 1871517912
Provider Name (Legal Business Name): CLARK STEVEN MCCOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E ELIZABETH ST STE 2
FORT COLLINS CO
80524-4044
US

IV. Provider business mailing address

1120 E ELIZABETH ST STE 2
FORT COLLINS CO
80524-4044
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-9193
  • Fax:
Mailing address:
  • Phone: 970-493-9193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCDRH.0054001
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2019-0018
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD2019-0018
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: