MEDICARE: REGINALD R 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	207W00000X	Ophthalmology Physician	ME0017225	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356443444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINALD R MCKINNEY M.D.

Provider Business Mailing Address
First Line	:	4875 NW 7TH AVENUE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-2303
Country	:	US
Telephone Number	:	305-751-0988
Fax Number	:	305-751-0989

Provider Business Practice Location Address
First Line	:	4875 NW 7TH AVENUE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-2303
Country	:	US
Telephone Number	:	305-751-0988
Fax Number	:	305-751-0989

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	11/21/2011

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