Individual
LORENZO DOW MCKNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 635-7651
(573) 659-4515
Mailing address
1125 MADISON ST, PO BOX 1128, JEFFERSON CITY, MO 65101-5227
(573) 635-7651
(573) 659-4515
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R4N29
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-04436
UNITED HEALTHCARE
MO
01
—
10118C002
BC/BS
MO
01
—
105908
MERCY HEALTH PLANS
MO
01
—
109986
BLUE CHOICE
MO
01
—
110147220
RR MEDICARE
MO
01
—
17066
GROUP HEALTH PLAN
MO
05
—
242956837
—
MO
01
—
5833167
AETNA
MO
Enumeration date
08/21/2006
Last updated
08/08/2012
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