Healthcare Provider Details

I. General information

NPI: 1508912403
Provider Name (Legal Business Name): JUSTIN L MCCOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 NW 56TH SUITE 206
OKLA CITY OK
73112-4426
US

IV. Provider business mailing address

3330 NW 56TH SUITE 206
OKLA CITY OK
73112-4426
US

V. Phone/Fax

Practice location:
  • Phone: 405-945-4710
  • Fax: 405-562-9242
Mailing address:
  • Phone: 405-945-4710
  • Fax: 405-562-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-15351
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA11332000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC178579
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number23976
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: