Provider Demographics
NPI:1124075742
Name:OYCO, JOSE L (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:OYCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 634715
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1333 SOUTHVIEW DR
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4317
Practice Address - Country:US
Practice Address - Phone:304-327-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09397207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0079420000Medicaid
VA1124075742Medicaid
WVP00233407OtherRAILROAD MEDICARE
WVP00358952OtherRAILROAD
WVOY0411485Medicare PIN
WVP00233407OtherRAILROAD MEDICARE
WVP00358952OtherRAILROAD