Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2003008352 | MO |
N | 2080P0204X | Pediatric Emergency Doctor | 2003008352 | MO |
Y | 2080P0208X | Pediatric Infectious Diseases | 2003008352 | MO |
NPI | 1609892827 |
---|---|
Provider Name | Dr. Jeffrey Scott Mckinney |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 09/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
208831206 | (05) | MO |
G74992 | (02) |