Healthcare Provider Details

I. General information

NPI: 1932377603
Provider Name (Legal Business Name): HEATHER A. MCKENZIE, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 MEDICAL DR
SAN ANTONIO TX
78229-4801
US

IV. Provider business mailing address

PO BOX 2074
SAN ANTONIO TX
78297-2074
US

V. Phone/Fax

Practice location:
  • Phone: 210-592-5314
  • Fax: 210-592-5452
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberL6110
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberL6110
License Number StateTX

VIII. Authorized Official

Name: DORIS A DOEGE
Title or Position: MANAGED CARE COORDINATOR
Credential:
Phone: 210-804-5416