Provider Demographics
NPI:1447247416
Name:MCCOY, GREGORY BUEL (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BUEL
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:1130 NW 22ND AVE
Practice Address - Street 2:STE 535
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2900
Practice Address - Country:US
Practice Address - Phone:503-297-4999
Practice Address - Fax:503-796-9884
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD13218208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A008OtherTRICARE
C91743OtherPROVIDENCE HEALTH
003395008OtherBLUE CROSS OR ALL
930766376OtherADVENTIST MEDICAL
WA7858004Medicaid
WA1040765Medicaid
OR109371Medicaid
930766376OtherCAREOREGON
M677AOtherHEALTH NET
OR180133Medicaid
003395000OtherBLUE CROSS OR ALL
WA128281OtherDEPT OF LABOR A
WA0079880OtherDEPT OF LABOR A
WA7858004Medicaid
CP7690Medicare ID - Type UnspecifiedMEDICARE RAILROAD
WA1040765Medicaid
OR181237Medicare PIN
A008OtherTRICARE
ORP01503640Medicare PIN