Provider Demographics
NPI:1154708667
Name:MCCOY, LEON
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:MCCOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7582 SW HUNZIKER ST
Mailing Address - Street 2:44
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8222
Mailing Address - Country:US
Mailing Address - Phone:503-758-0376
Mailing Address - Fax:
Practice Address - Street 1:7582 SW HUNZIKER ST
Practice Address - Street 2:44
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8222
Practice Address - Country:US
Practice Address - Phone:503-758-0376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist