MEDICARE: ROBERT E MCCOY, MD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	A43126	CA

General Provider Information

NPI Number	:	1053451757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT E MCCOY, MD, INC.

Provider Business Mailing Address
First Line	:	1440 N HARBOR BLVD
Second Line	:	STE 100
City	:	FULLERTON
State	:	CA
Zip	:	92835-4127
Country	:	US
Telephone Number	:	714-447-3144
Fax Number	:	714-447-1944

Provider Business Practice Location Address
First Line	:	1440 N HARBOR BLVD
Second Line	:	STE 100
City	:	FULLERTON
State	:	CA
Zip	:	92835-4127
Country	:	US
Telephone Number	:	714-447-3144
Fax Number	:	714-447-1944

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT EMMITT MCCOY
Credential	:	MD
Telephone Number	:	714-447-3144

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	01/20/2012

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