Healthcare Provider Details

I. General information

NPI: 1447477708
Provider Name (Legal Business Name): DOUGLAS J. MACKENZIE, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 STATE ST SUITE 102
SANTA BARBARA CA
93101-2458
US

IV. Provider business mailing address

1722 STATE ST SUITE 102
SANTA BARBARA CA
93101-2458
US

V. Phone/Fax

Practice location:
  • Phone: 805-898-0700
  • Fax: 805-898-0600
Mailing address:
  • Phone: 805-898-0700
  • Fax: 805-898-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA48683
License Number StateCA

VIII. Authorized Official

Name: DR. DOUGLAS J. MACKENZIE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-898-0700