Individual
JASON DANIEL MCCOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT, SLT
Contact information
Practice address
925 W PIONEER PKWY, SUITE D., GRAND PRAIRIE, TX 75051-4735
(214) 412-2079
Mailing address
925 W PIONEER PKWY, SUITE D., GRAND PRAIRIE, TX 75051-4735
(214) 412-2079
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT107088
TX
247200000X
Other Technician
ZP10218
TX
Other
Enumeration date
05/01/2014
Last updated
05/01/2014
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