Healthcare Provider Details

I. General information

NPI: 1053312017
Provider Name (Legal Business Name): CRAIG E MCCOY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 UNION AVE STE 1600
MOBERLY MO
65270-9404
US

IV. Provider business mailing address

1513 UNION AVE STE 1600
MOBERLY MO
65270-9404
US

V. Phone/Fax

Practice location:
  • Phone: 660-269-8752
  • Fax: 660-269-8753
Mailing address:
  • Phone: 660-269-8752
  • Fax: 660-269-8753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number105156
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: