Healthcare Provider Details

I. General information

NPI: 1407443856
Provider Name (Legal Business Name): MCKENZIE BRYN CUMMINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MCKENZIE BRYN LIBERTY-BIBBENS DO

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N CAMPBELL AVE
TUCSON AZ
85719-4330
US

IV. Provider business mailing address

1625 N CAMPBELL AVE
TUCSON AZ
85719-4330
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-4111
  • Fax:
Mailing address:
  • Phone: 520-874-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberR4038
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: