Provider Demographics
NPI:1225170103
Name:MCKENNA, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4214 ANDREWS HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4817
Mailing Address - Country:US
Mailing Address - Phone:432-685-0633
Mailing Address - Fax:432-685-1043
Practice Address - Street 1:400 ROSALIND REDFERN GROVER PKWY STE 271
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5857
Practice Address - Country:US
Practice Address - Phone:432-221-2700
Practice Address - Fax:432-221-2702
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE-4516207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1103996-02Medicaid
TX00MK18Medicare ID - Type Unspecified