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General NPI Number Information
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NPI Number | 1891799821
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Entity Type | Individual
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Provider Name | BRUCE A MACKEY MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 3957 E COVELL RD
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City | EDMOND
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State | OK
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Zip | 73034-6909
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Country | US
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Telephone | 405-285-7246
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Fax | 405-285-7546
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Provider Business Mailing Address
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Address Line | 3957 E COVELL RD
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City | EDMOND
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State | OK
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Zip | 73034-6909
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Country | US
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Telephone | 405-285-7246
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Fax | 405-285-7546
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 16205
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License Number State | OK
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