MEDICARE: BENJAMIN MCKINNEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	53905	TX

General Provider Information

NPI Number	:	1306250287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN MCKINNEY M.D.

Provider Business Mailing Address
First Line	:	2622 LOBDELL ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-3816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2835 AL LIPSCOMB WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-1647
Country	:	US
Telephone Number	:	214-421-1783
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2014
Last Update Date	:	04/05/2022

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