Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | A48683 | CA |
NPI | 1174557623 |
---|---|
Provider Name | Douglas Joseph Mackenzie |
First Address | Santa Barbara, CA 93105-3804 |
Second Address | Santa Barbara, CA 93105-3804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 19/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
X55433 | (02) |