Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | H1138 | TX |
NPI | 1114926276 |
---|---|
Provider Name | Donald Mackenzie |
First Address | Plano, TX 75024-2954 |
Second Address | Plano, TX 75024-2954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 28/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A02127 | (02) |