Healthcare Provider Details

I. General information

NPI: 1053400994
Provider Name (Legal Business Name): JOSEPH MATTHEW MCKINLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 TURIN TER
ST AUGUSTINE FL
32092-0848
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-2260
  • Fax:
Mailing address:
  • Phone: 904-819-2260
  • Fax: 352-627-8067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME94561
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: