Healthcare Provider Details

I. General information

NPI: 1194873539
Provider Name (Legal Business Name): WILLIAM TONY MCKENZIE MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 JENKS AVE # 1
PANAMA CITY FL
32401-2442
US

IV. Provider business mailing address

1397 JENKS AVE # 1
PANAMA CITY FL
32401-2442
US

V. Phone/Fax

Practice location:
  • Phone: 850-522-5864
  • Fax: 850-522-5863
Mailing address:
  • Phone: 850-522-5864
  • Fax: 850-522-5863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0093485
License Number StateFL

VIII. Authorized Official

Name: DR. WILLIAM TONY MCKENZIE
Title or Position: OWNER
Credential: M.D.
Phone: 850-522-5864