Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 8740A | WY |
N | 207X00000X | Orthopaedic Surgeon | MD433175 | PA |
NPI | 1023295938 |
---|---|
Provider Name | Dr. Mark E. Mckenna |
First Address | Laramie, WY 82070-5530 |
Second Address | Laramie, WY 82070-5530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2008 |
Last Update Date | 11/09/2020 |