Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RP1001X | Pulmonary Disease | 25MA05394400 | NJ |
Y | 207RP1001X | Pulmonary Disease | 35.120455 | OH |
NPI | 1053425637 |
---|---|
Provider Name | Robert A Mckinley |
First Address | Marietta, OH 45750-0449 |
Second Address | Marietta, OH 45750-1644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 14/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0076874 | (05) | OH |
1752600 | (05) | NJ |
E84587 | (02) | NJ |