Provider Demographics
NPI:1720020829
Name:MCKENNEY, SCOTT ALAN (MD, FACP)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:MCKENNEY
Suffix:
Gender:M
Credentials:MD, FACP
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:690 N 14TH ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1449
Practice Address - Country:US
Practice Address - Phone:409-899-7180
Practice Address - Fax:409-899-7186
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6932207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133981401Medicaid
TX133981402Medicaid
TX133981404Medicaid
TX133981405Medicaid
TX133981408Medicaid
TX133981409Medicaid
TX8R1502OtherBLUE CROSS OF TEXAS
TX8898K9Medicare PIN
TX8R1502OtherBLUE CROSS OF TEXAS
TX133981404Medicaid
TX89X562Medicare PIN
TX510930YZ21Medicare PIN
TX133981402Medicaid
TX8K8694Medicare PIN
TX900002993Medicare PIN