Provider Demographics
NPI:1265417331
Name:MCKAY, WILLIAM LEWIS (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LEWIS
Last Name:MCKAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1407
Mailing Address - Country:US
Mailing Address - Phone:417-466-4110
Mailing Address - Fax:417-466-4255
Practice Address - Street 1:108 S HICKORY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1407
Practice Address - Country:US
Practice Address - Phone:417-466-4110
Practice Address - Fax:417-466-4255
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5G53207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242356210Medicaid
080033246OtherRR MEDICARE
MO1265417331Medicaid
D41532Medicare UPIN
009050115Medicare ID - Type Unspecified
MOMA1327040Medicare PIN