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General NPI Number Information
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NPI Number | 1114189933
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Entity Type | Individual
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Provider Name | SHAUN PATRICK MCKENZIE MD
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Gender | Male
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 4101 JAMES CASEY ST STE 100
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City | AUSTIN
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State | TX
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Zip | 78745-1145
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Country | US
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Telephone | 512-421-4250
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 911230
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City | DALLAS
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State | TX
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Zip | 75391-1230
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Country | US
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Telephone | 972-997-8000
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Fax | 972-234-2987
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 43479
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | P6220
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License Number State | TX
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