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General NPI Number Information
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NPI Number | 1225170103
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Entity Type | Individual
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Provider Name | JOHN M MCKENNA MD
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 400 ROSALIND REDFERN GROVER PKWY STE 271
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City | MIDLAND
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State | TX
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Zip | 79701-5857
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Country | US
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Telephone | 432-221-2700
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Fax | 432-221-2702
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Provider Business Mailing Address
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Address Line | 4214 ANDREWS HWY STE 240
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City | MIDLAND
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State | TX
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Zip | 79703-4817
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Country | US
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Telephone | 432-685-0633
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Fax | 432-685-1043
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | E-4516
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License Number State | TX
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