Provider Demographics
NPI:1669688495
Name:MCKINNON, STEVE MALONE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:MALONE
Last Name:MCKINNON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 991
Mailing Address - Street 2:413
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-0991
Mailing Address - Country:US
Mailing Address - Phone:704-873-1463
Mailing Address - Fax:704-873-1367
Practice Address - Street 1:1835 DAVIE AVE
Practice Address - Street 2:413
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3578
Practice Address - Country:US
Practice Address - Phone:704-873-1463
Practice Address - Fax:704-873-1467
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2008-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC27825207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8957138Medicaid
NC8957138Medicaid
NC203325AMedicare PIN