Healthcare Provider Details

I. General information

NPI: 1972184489
Provider Name (Legal Business Name): RONALD HARRISON MCKENZIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E 29TH ST STE 202
LOVELAND CO
80538-2746
US

IV. Provider business mailing address

270 COPPERFIELD BLVD NE STE 202
CONCORD NC
28025-2441
US

V. Phone/Fax

Practice location:
  • Phone: 970-624-5170
  • Fax: 970-669-7521
Mailing address:
  • Phone: 704-721-2060
  • Fax: 704-403-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number303129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: