Provider Demographics
NPI:1750720181
Name:MCINNIS, IAN CHRISTOPHER (DO)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:CHRISTOPHER
Last Name:MCINNIS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3551 ROGER BROOKE DR.
Mailing Address - Street 2:SAN ANTONIO MILITARY MED CENTER, PULMONARY FELLOWSHIP
Mailing Address - City:JBSA-FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-5412
Mailing Address - Fax:210-916-0709
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:PULMONARY DISEASE CLINIC
Practice Address - City:JBSA-FSH
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-916-2153
Practice Address - Fax:210-916-0709
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2021-04-26
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Provider Licenses
StateLicense IDTaxonomies
NE1290207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine