MEDICARE: VERNON T MACKEY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	3535	AZ

General Provider Information

NPI Number	:	1003204975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERNON T MACKEY, PC

Provider Business Mailing Address
First Line	:	9191 W THUNDERBIRD RD STE D101
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-4270
Country	:	US
Telephone Number	:	623-977-6700
Fax Number	:	623-977-6771

Provider Business Practice Location Address
First Line	:	9191 W THUNDERBIRD RD STE D101
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-4270
Country	:	US
Telephone Number	:	623-977-6700
Fax Number	:	623-977-6771

Authorized Official
Title or Position	:	MANAGER
Name	:	SHELLY MACKEY
Credential	:
Telephone Number	:	623-977-6700

Provider Enumeration Date	:	12/31/2014
Last Update Date	:	12/31/2014

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