MEDICARE: DR. JAMES SAN 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	208600000X	Surgery Physician	51001	AZ

General Provider Information

NPI Number	:	1801107099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES SAN MCKINNEY M.D.

Provider Business Mailing Address
First Line	:	1739 E BEVERLY AVE
Second Line	:	STE. 200
City	:	KINGMAN
State	:	AZ
Zip	:	86409-3593
Country	:	US
Telephone Number	:	928-263-4547
Fax Number	:	928-263-4794

Provider Business Practice Location Address
First Line	:	3104 N STOCKTON HILL RD
Second Line	:	MOHAVE SURGICAL SPECIALISTS
City	:	KINGMAN
State	:	AZ
Zip	:	86401-4183
Country	:	US
Telephone Number	:	928-681-8720
Fax Number	:

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

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	06/03/2016

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