Healthcare Provider Details

I. General information

NPI: 1295714525
Provider Name (Legal Business Name): CAMERON RAFAEL MCKAY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N STAPLEY DR
MESA AZ
85203-8057
US

IV. Provider business mailing address

220 N STAPLEY DR
MESA AZ
85203-8057
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-5966
  • Fax: 480-962-9173
Mailing address:
  • Phone: 480-833-5966
  • Fax: 480-962-9173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberAZ161
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: