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General NPI Number Information
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NPI Number | 1144768276
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Entity Type | Organization
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Legal Business Name | JOHN M MCKINNEY JR PA
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 3417 TAMIAMI TRL SUITE G
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8158
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Country | US
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Telephone | 941-235-7246
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Fax | 941-235-2222
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Provider Business Mailing Address
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Address Line | 3417 TAMIAMI TRL SUITE G
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8158
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Country | US
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Telephone | 941-235-7246
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Fax | 941-235-2222
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN M MCKINNEY
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Credential | MD
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Telephone | 321-698-0258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | ME66933
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License Number State | FL
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