Provider Demographics
NPI:1174558001
Name:MCCOY, DANIEL W (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:MCCOY
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 1:130 MEDICAL PARK PL
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8051
Mailing Address - Country:US
Mailing Address - Phone:501-624-0123
Mailing Address - Fax:
Practice Address - Street 1:130 MEDICAL PARK PL
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8051
Practice Address - Country:US
Practice Address - Phone:501-624-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.31531208G00000X
ARE-0994208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL192086Medicaid
AL192086Medicaid
VA1174558001Medicaid