Provider Demographics
NPI:1447683487
Name:MCGINN, BRIAN T (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:MCGINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:T
Other - Last Name:BOEHMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:53865 SALEM LN
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:MO
Mailing Address - Zip Code:63436-2251
Mailing Address - Country:US
Mailing Address - Phone:309-737-4128
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6877
Practice Address - Country:US
Practice Address - Phone:573-221-5250
Practice Address - Fax:573-231-3723
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018016506208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics