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	207NS0135X	Procedural Dermatology Physician	3535	AZ

General Provider Information

NPI Number	:	1396959417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERNON T MACKEY PC

Provider Business Mailing Address
First Line	:	9191 W THUNDERBIRD RD
Second Line	:	SUITE D-101
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
Second Line	:	SUITE D-101
City	:	PEORIA
State	:	AZ
Zip	:	85381-4270
Country	:	US
Telephone Number	:	623-977-6700
Fax Number	:	623-977-6771

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. VERNON T MACKEY
Credential	:	D.O.
Telephone Number	:	623-977-6700

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	09/15/2023

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