Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 042.0012187 | VT |
N | 103T00000X | Psychologist | 042.0012187 | VT |
N | 207RA0401X | Internist - Addiction Medicine | 042.0012187 | VT |
NPI | 1548218555 |
---|---|
Provider Name | Dean Wm Mckenzie |
First Address | Marana, AZ 85653-0188 |
Second Address | Marana, AZ 85653-7008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000606339A | (05) | GA |
04391255 | (05) | NY |
1019195 | (05) | VT |
372326 | (05) | AZ |
E98149 | (02) | GA |