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General NPI Number Information
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NPI Number | 1386900595
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Entity Type | Individual
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Provider Name | TRAVIS TODD MCKENZIE D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 4401 HARRISON BLVD
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City | OGDEN
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State | UT
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Zip | 84403
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Country | US
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Telephone | 801-387-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 5444 S GREEN ST
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City | MURRAY
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State | UT
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Zip | 84123-5632
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Country | US
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Telephone | 801-313-4110
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Fax |
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 10246349-1204
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 10246349-1204
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License Number State | UT
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