Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | E4388 | AR |
NPI | 1003831462 |
---|---|
Provider Name | Allan Dee Mckenzie |
First Address | Little Rock, AR 72205-3858 |
Second Address | Little Rock, AR 72205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 10/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06080012300 | QUALCHOICE (01) | AR |
162394001 | (05) | AR |
2674768 | UNITED HEALTHCARE (01) | AR |
7203815 | AETNA (01) | AR |
764178 | HEALTHLINK (01) | AR |
I61644 | (02) | AR |