Provider Demographics
NPI:1316156284
Name:MCKEE, DESIRAE M (MD)
Entity type:Individual
Prefix:
First Name:DESIRAE
Middle Name:M
Last Name:MCKEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2201
Mailing Address - Country:US
Mailing Address - Phone:602-677-8320
Mailing Address - Fax:
Practice Address - Street 1:5613 114TH
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424
Practice Address - Country:US
Practice Address - Phone:602-677-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8220208600000X, 2086S0105X
NY243665-12086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184699101OtherFIRSTCARE
TX204376201Medicaid
TX8CB132OtherBCBS TX PPO
TXP00808918OtherRR MEDICARE
NM00NM005X56Medicaid
NY22889696Medicaid
NM77884736Medicaid
TX204376202Medicaid
TX8CB132OtherBCBS TX PPO
NYRB5353Medicare PIN