Individual
RUSSEL T MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1325 N 600 E STE 101, LOGAN, UT 84341
(435) 750-5599
(435) 750-0861
Mailing address
1325 N 600 E STE 101, LOGAN, UT 84341
(435) 750-5599
(435) 750-0861
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2851791204
UT
Other
Enumeration date
08/05/2006
Last updated
07/08/2007
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