Healthcare Provider Details

I. General information

NPI: 1992923874
Provider Name (Legal Business Name): RICHARD BRIAN MACKEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 E KIMBALLS LN STE 207
DRAPER UT
84020-5021
US

IV. Provider business mailing address

PO BOX 100253
ATLANTA GA
30384-0253
US

V. Phone/Fax

Practice location:
  • Phone: 801-576-2300
  • Fax: 844-249-1746
Mailing address:
  • Phone: 801-568-5972
  • Fax: 844-249-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number7276060-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number7276030-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: