MEDICARE: GREGORY H MCKINNIS MD

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	19047	OK
2	207RP1001X	Pulmonary Disease Physician	19047	OK
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	19047	OK

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	:	1972542207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY H MCKINNIS MD

Provider Business Mailing Address
First Line	:	PO BOX 2118
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73101-2118
Country	:	US
Telephone Number	:	405-232-5555
Fax Number	:	405-270-0551

Provider Business Practice Location Address
First Line	:	608 NW 9TH
Second Line	:	SUITE 2100
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-1049
Country	:	US
Telephone Number	:	405-232-5555
Fax Number	:	405-270-0551

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	10/15/2012

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Directions to “ GREGORY H MCKINNIS MD” Practice Location

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