Healthcare Provider Details

I. General information

NPI: 1326060682
Provider Name (Legal Business Name): WILLIAM TONY MCKENZIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
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 TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0093485
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME00934585
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME0093485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: