Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | R6B87 | MO |
NPI | 1033173398 |
---|---|
Provider Name | Dr. John Wade Mckinney |
First Address | Bourbon, MO 65441-8159 |
Second Address | Bourbon, MO 65441-8159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 20/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040009014 | RAILROAD MEDICARE (01) |