Provider Demographics
NPI:1326006917
Name:MCCANN, JOHN DAVID (MD PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:MCCANN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 FORUM KATY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6583
Mailing Address - Country:US
Mailing Address - Phone:573-441-7070
Mailing Address - Fax:573-441-2288
Practice Address - Street 1:1410 FORUM KATY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6583
Practice Address - Country:US
Practice Address - Phone:573-441-7070
Practice Address - Fax:573-441-2288
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2899121205207W00000X, 2086S0122X
MO20220375782086S0122X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506327Medicaid
PAR TAX IDOtherGEHA
1057048OtherCCN
521709OtherDMBA
ID805502900Medicaid
UT107030566101OtherIHC SELECT HEALTH
107030566101OtherIHC
5069010OtherAETNA
PAR TAX IDOtherBEECH STREET
WY114400600Medicaid
8806278OtherCIGNA
PAR TAX IDOtherMAILHANDLERS
015005OtherALTIUS
1057048OtherFIRST HEALTH
PAR TAX IDOtherBLUE CROSS OF CA
G12029Medicare UPIN
107030566101OtherIHC
ID805502900Medicaid
NV100506327Medicaid
WY114400600Medicaid