MEDICARE: MARY SUZANNE MCKENZIE MD

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	207RP1001X	Pulmonary Disease Physician	166587	OR
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	166587	OR

General Provider Information

NPI Number	:	1447417100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SUZANNE MCKENZIE MD

Provider Business Mailing Address
First Line	:	19250 SW 65TH AVE STE 137
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-7745
Country	:	US
Telephone Number	:	503-413-6499
Fax Number	:

Provider Business Practice Location Address
First Line	:	19250 SW 65TH AVE STE 137
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-7745
Country	:	US
Telephone Number	:	503-413-6499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	08/14/2014

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