Individual
RANDALL WADE MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1713 S FM 51, SUITE 103, DECATUR, TX 76234
(940) 627-6976
(940) 627-3491
Mailing address
1713 S FM 51, SUITE 103, DECATUR, TX 76234
(940) 627-6976
(940) 627-3491
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
J0118
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131938605
—
TX
01
—
89Z590
BCBSTX
TX
Enumeration date
04/19/2006
Last updated
09/18/2019
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