Healthcare Provider Details

I. General information

NPI: 1821007741
Provider Name (Legal Business Name): THOMAS D MACKENZIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST MC 7782
DENVER CO
80204-4507
US

IV. Provider business mailing address

777 BANNOCK ST MC 7782
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number30983
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30983
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: