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General NPI Number Information
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NPI Number | 1316135510
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Entity Type | Organization
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Legal Business Name | DAVID MCKENZIE MD PC
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 1808 E AZTEC AVE STE 6
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City | GALLUP
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State | NM
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Zip | 87301-4946
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Country | US
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Telephone | 505-863-9374
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Fax |
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Provider Business Mailing Address
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Address Line | 1808 E AZTEC AVE STE 6
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City | GALLUP
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State | NM
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Zip | 87301-4946
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Country | US
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Telephone | 505-863-9374
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MARIAN MCKENZIE
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Credential | BUSINESS MANAGER
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Telephone | 505-863-9374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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