Healthcare Provider Details

I. General information

NPI: 1962518191
Provider Name (Legal Business Name): MICHAEL WAYNE MCCOY M.D.P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 IRA E WOODS AVE
GRAPEVINE TX
76051-4012
US

IV. Provider business mailing address

811 IRA E WOODS AVE
GRAPEVINE TX
76051-4012
US

V. Phone/Fax

Practice location:
  • Phone: 817-481-3585
  • Fax: 817-421-6529
Mailing address:
  • Phone: 817-481-3585
  • Fax: 817-421-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH5589
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberH5589
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: