Individual
CLARK STEVEN MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
CDRH.0054001
CO
207Q00000X
Family Medicine Physician
MD2019-0018
NM
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
MD2019-0018
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19505523
—
NM
05
—
250902400
—
FL
01
—
258651
AVMED
—
01
—
31540
BCBS
—
Enumeration date
07/26/2006
Last updated
12/12/2023
Update your record
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