Provider Demographics
NPI:1003866179
Name:MCKINNEY, SCOTT W (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3692 E SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3137
Mailing Address - Country:US
Mailing Address - Phone:713-946-1500
Mailing Address - Fax:713-946-0200
Practice Address - Street 1:3692 E SAM HOUSTON PKWY S
Practice Address - Street 2:SUITE 100
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3137
Practice Address - Country:US
Practice Address - Phone:713-946-1500
Practice Address - Fax:713-946-0200
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1103213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121564203Medicaid
TX89W170Medicare PIN
TXU13666Medicare UPIN