Provider Demographics
NPI:1164446399
Name:MCKENNA, WILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 TREASURE HILLS BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8913
Mailing Address - Country:US
Mailing Address - Phone:956-425-9240
Mailing Address - Fax:956-412-8575
Practice Address - Street 1:1713 TREASURE HILLS BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8913
Practice Address - Country:US
Practice Address - Phone:956-425-9240
Practice Address - Fax:956-412-8575
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8709207K00000X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035867301Medicaid
TX00SH68Medicare ID - Type Unspecified
TXC19171Medicare UPIN