MEDICARE: REGINALD R MCKINNEY MD PA

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

General Provider Information

NPI Number	:	1366621773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGINALD R MCKINNEY MD PA

Provider Business Mailing Address
First Line	:	4875 NW 7TH AVE
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 AVE
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	:	PRESIDENT
Name	:	REGINALD R MCKINNEY
Credential	:	MD
Telephone Number	:	305-751-0988

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	11/01/2007

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