Provider Demographics
NPI:1801090766
Name:MCCOY, CHRISTOPHER DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-215-9790
Mailing Address - Fax:254-215-0900
Practice Address - Street 1:120 HILLCREST MEDICAL BLVD STE 3053
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8948
Practice Address - Country:US
Practice Address - Phone:254-215-9790
Practice Address - Fax:254-215-0900
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7157207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX325437702Medicaid
TX325437701Medicaid
TX8DV663OtherBCBS
TX8ET192OtherBCBS
TX325437703Medicaid
TX325437704Medicaid
TX8ET192OtherBCBS
TX298052YRLZMedicare PIN
TX325437701Medicaid
TX325437703Medicaid