Individual
CLARK STEVEN MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 E ELIZABETH ST STE 2, FORT COLLINS, CO 80524-4044
(970) 493-9193
Mailing address
1120 E ELIZABETH ST STE 2, FORT COLLINS, CO 80524-4044
(970) 493-9193
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
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