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NPI Code Detail

MEDICARE: JOHN P MCKENZIE III M D INC

MEDICARE: JOHN P MCKENZIE III M D INC
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
1207RC0000XCardiovascular Disease PhysicianG71752CA
2207RC0001XClinical Cardiac Electrophysiology PhysicianG71752CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316982762
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHN P MCKENZIE III M D INC
Provider Business Mailing Address
First Line : 1510 S CENTRAL AVE
Second Line : SUITE 150
City : GLENDALE
State : CA
Zip : 91204-2500
Country : US
Telephone Number : 818-247-0346
Fax Number :
Provider Business Practice Location Address
First Line : 660 W BROADWAY
Second Line :
City : GLENDALE
State : CA
Zip : 91204-1008
Country : US
Telephone Number : 818-502-9420
Fax Number : 818-243-9605
Authorized Official
Title or Position : PHYSICIAN
Name : DR. JOHN PAUL MCKENZIE III
Credential : M.D.
Telephone Number : 818-502-9420
Provider Enumeration Date : 06/19/2006
Last Update Date : 06/30/2009

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Directions to “JOHN P MCKENZIE III M D INC ” Practice Location

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