Provider Demographics
NPI:1992732986
Name:COY, THOMAS B (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:COY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803
Mailing Address - Country:US
Mailing Address - Phone:417-347-7272
Mailing Address - Fax:417-347-7915
Practice Address - Street 1:3302 MCINTOSH CIR
Practice Address - Street 2:STE 1
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3648
Practice Address - Country:US
Practice Address - Phone:417-347-7272
Practice Address - Fax:417-347-7915
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO114648208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO249812405Medicaid
OK100055980BMedicaid
KS100318490BMedicaid
MO131363OtherANTHEM
020054312OtherRR MEDICARE
MO001013818Medicare PIN
020054312OtherRR MEDICARE