Healthcare Provider Details

I. General information

NPI: 1972542207
Provider Name (Legal Business Name): GREGORY H MCKINNIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH SUITE 2100
OKLAHOMA CITY OK
73102-1049
US

IV. Provider business mailing address

PO BOX 2118
OKLAHOMA CITY OK
73101-2118
US

V. Phone/Fax

Practice location:
  • Phone: 405-232-5555
  • Fax: 405-270-0551
Mailing address:
  • Phone: 405-232-5555
  • Fax: 405-270-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number19047
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number19047
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number19047
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: