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Individual
GERALD LEROY MCKINSEY
Active
Individual
GERALD LEROY MCKINSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA17303
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD069A
MEDICARE - GROUP PTAN
CA
05
—
PA17303
—
CA
Enumeration date
05/24/2006
Last updated
08/02/2016
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