Provider Demographics
NPI:1043371222
Name:MCKINNEY, WILLIAM DENT JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DENT
Last Name:MCKINNEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:HC 63 BOX 1094
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:63623
Mailing Address - Country:US
Mailing Address - Phone:573-697-5818
Mailing Address - Fax:573-697-5820
Practice Address - Street 1:1 MACK LANE
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:MO
Practice Address - Zip Code:63623
Practice Address - Country:US
Practice Address - Phone:573-697-5818
Practice Address - Fax:573-697-5820
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO35836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A11853Medicare UPIN