Provider Demographics
NPI:1952474603
Name:MCKEEVER, GREGORY C (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:C
Last Name:MCKEEVER
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:PO BOX 8570
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-0010
Mailing Address - Country:US
Mailing Address - Phone:936-295-8000
Mailing Address - Fax:936-439-1169
Practice Address - Street 1:100 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 1000
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4945
Practice Address - Country:US
Practice Address - Phone:936-295-8000
Practice Address - Fax:936-439-1169
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
89W427Medicare PIN
TXG33705Medicare UPIN