MEDICARE: ANDREW K MCKAY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	K1254	TX
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	K1254	TX

General Provider Information

NPI Number	:	1114010964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW K MCKAY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2569
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77497-2569
Country	:	US
Telephone Number	:	713-664-1330
Fax Number	:	713-664-3355

Provider Business Practice Location Address
First Line	:	10926 EAST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77029-1912
Country	:	US
Telephone Number	:	713-330-4737
Fax Number	:	713-330-4800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/25/2009

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