Healthcare Provider Details

I. General information

NPI: 1568501997
Provider Name (Legal Business Name): SCOTT H MACKENZIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 W COLFAX AVE STE B
LAKEWOOD CO
80214-5434
US

IV. Provider business mailing address

3333 S WADSWORTH BLVD UNIT D100
LAKEWOOD CO
80227-5117
US

V. Phone/Fax

Practice location:
  • Phone: 303-573-9951
  • Fax: 303-573-1013
Mailing address:
  • Phone: 303-205-1090
  • Fax: 303-205-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number45360
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: