MEDICARE: DR. RENE MACKINNON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	0101271181	VA
2	390200000X	Student in an Organized Health Care Education/Training Program		MD

General Provider Information

NPI Number	:	1083279863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENE MACKINNON MD

Provider Business Mailing Address
First Line	:	NAVAL HOSPITAL JACKSONVILLE 2080 CHILD STREET
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAVAL HOSPITAL JACKSONVILLE 2080 CHILD STREET
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-0001
Country	:	US
Telephone Number	:	904-542-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	12/07/2025

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