MEDICARE: DR. BRICE W MCKANE 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	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	M1233	TX
2	208200000X	Plastic Surgery Physician	M1233	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00Y152	OTHER	TX	MEDICARE GROUP PTAN

General Provider Information

NPI Number	:	1154481778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRICE W MCKANE M.D.

Provider Business Mailing Address
First Line	:	12201 MERIT DR STE 440
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-3106
Country	:	US
Telephone Number	:	469-501-1466
Fax Number	:	469-501-1465

Provider Business Practice Location Address
First Line	:	12201 MERIT DR STE 440
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-3106
Country	:	US
Telephone Number	:	469-501-1466
Fax Number	:	469-501-1465

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/14/2025

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Directions to “ DR. BRICE W MCKANE M.D.” Practice Location

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