Provider Demographics
NPI:1871582981
Name:MCCOY, VICTOR A (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:A
Last Name:MCCOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8338 SUMMA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3669
Mailing Address - Country:US
Mailing Address - Phone:225-761-8988
Mailing Address - Fax:225-761-8940
Practice Address - Street 1:8338 SUMMA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3669
Practice Address - Country:US
Practice Address - Phone:225-761-8988
Practice Address - Fax:225-761-8940
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.14498R2085N0700X
NC2003003802085N0700X
TXK78222085N0700X
ORMD269662085N0700X
MS190872085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1570222Medicaid
LA4J6257545Medicare PIN
LAH07788Medicare UPIN