Provider Demographics
NPI:1316000409
Name:WILLIAM B MCKINNEY, M.D., P.A.
Entity Type:Organization
Organization Name:WILLIAM B MCKINNEY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-631-1020
Mailing Address - Street 1:3000 E FLETCHER AVE
Mailing Address - Street 2:SUITE # 230
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4656
Mailing Address - Country:US
Mailing Address - Phone:813-631-1020
Mailing Address - Fax:813-971-3787
Practice Address - Street 1:3000 E FLETCHER AVE
Practice Address - Street 2:SUITE # 230
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4656
Practice Address - Country:US
Practice Address - Phone:813-631-1020
Practice Address - Fax:813-971-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0088012174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG55564Medicare UPIN
FLK4852Medicare ID - Type UnspecifiedGROUP NUMBER