Individual
JOHN RONALD MCKINNEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-4262
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
119484
MO
207P00000X
Emergency Medicine Physician
Primary
L4566
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0074PT
BCBS
TX
05
—
154641808
—
TX
05
—
154641809
—
TX
05
—
154641810
—
TX
05
—
154641813
—
TX
01
—
750818167022
TRICARE
TX
01
—
8X8169
BCBS
TX
01
—
TIN PLUS 005
TRICARE JV LOCATION
TX
01
—
TIN PLUS 015
TRICARE MFH LOCATION
TX
01
—
TIN PLUS 044
TRICARE MFH WINNSBORO LOCATION
TX
Enumeration date
07/02/2006
Last updated
11/07/2012
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