Healthcare Provider Details

I. General information

NPI: 1851338602
Provider Name (Legal Business Name): BRIAN D MCCOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S GLOSTER ST
TUPELO MS
38801-4934
US

IV. Provider business mailing address

105 RIDGEVIEW CV
TUPELO MS
38801-0400
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-4161
  • Fax:
Mailing address:
  • Phone: 662-407-0943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number17680
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number17680
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: