Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | M0486 | TX |
NPI | 1467489799 |
---|---|
Provider Name | Dr. Gregory J Mckenna |
First Address | Dallas, TX 75246-2003 |
Second Address | Dallas, TX 75246-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 21/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1723074-01 | (05) | TX |
1723074-02 | (05) | TX |
8H3718 | BCBS (01) | TX |
I23888 | (02) | TX |