Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2000151554 | MO |
NPI | 1003809195 |
---|---|
Provider Name | Dr. Joseph T. Mackey |
First Address | Blue Springs, MO 64014 |
Second Address | Blue Springs, MO 64014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 02/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2381481 | AETNA (01) | MO |
27055015 | BC/BS (01) | MO |
H25605 | (02) | MO |