Healthcare Provider Details

I. General information

NPI: 1265417331
Provider Name (Legal Business Name): WILLIAM LEWIS MCKAY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S HICKORY ST
MOUNT VERNON MO
65712-1407
US

IV. Provider business mailing address

108 S HICKORY ST
MOUNT VERNON MO
65712-1407
US

V. Phone/Fax

Practice location:
  • Phone: 417-466-4110
  • Fax: 417-466-4255
Mailing address:
  • Phone: 417-466-4110
  • Fax: 417-466-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR5G53
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: