Provider Demographics
NPI:1316945819
Name:MCKINNON, BRIAN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOHN
Last Name:MCKINNON
Suffix:
Gender:M
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:PO BOX 650859, DEPT. 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0859
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:
Practice Address - Street 1:1600 W LEAGUE CITY PKWY, STE D
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6442
Practice Address - Country:US
Practice Address - Phone:281-338-0829
Practice Address - Fax:281-557-7284
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2843207Y00000X
PA​ MD457465207YX0901X
TN​ 49277207YX0901X
GA​ 057724207YX0901X
SC​ 29225207YX0901X
MD​ D0042364207YX0901X
MA​ 266323207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032208420002Medicaid
PA549270UQEMedicare Oscar/Certification