Individual
DR. JUSTIN MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
O-0857
ID
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
DR.0057008
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265792238
—
ID
Enumeration date
05/23/2012
Last updated
05/25/2023
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