Basic Information
| Provider Information | |||||||||
| NPI: | 1437597747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCOY | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | ELLIS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2360 MCKEE RD STE 10 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951161618 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2360 MCKEE RD STE 10 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087297128 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2013 | ||||||||
| LastUpdateDate: | 01/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 141087 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 390200000X | 256533 | MA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.