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General NPI Number Information
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NPI Number | 1114942273
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Entity Type | Individual
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Provider Name | SIMON JOHN MCKEOWN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 3626 S CLARK ST
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City | MEXICO
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State | MO
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Zip | 65265-4104
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Country | US
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Telephone | 573-581-1812
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Fax | 573-581-1471
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Provider Business Mailing Address
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Address Line | P.O. BOX 478
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City | MEXICO
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State | MO
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Zip | 65265
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Country | US
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Telephone | 573-581-8127
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Fax | 573-582-7053
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2004021597
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2004021597
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License Number State | MO
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