Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | E8709 | TX |
NPI | 1164446399 |
---|---|
Provider Name | William R Mckenna |
First Address | Harlingen, TX 78550-8913 |
Second Address | Harlingen, TX 78550-8913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
035867301 | (05) | TX |
C19171 | (02) | TX |