Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | C10004167 | DE |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | C10004167 | DE |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MD054069L | PA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | ME130481 | FL |
NPI | 1760574552 |
---|---|
Provider Name | Dr. William G. Mackenzie |
First Address | Rockland, DE 19732-0191 |
Second Address | Wilmington, DE 19803-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 15/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025435100 | (05) | NE |
1426596 | (05) | PA |
1511416 | (05) | MD |
1523064 | (05) | NY |
166618 | (05) | OH |
3671585-00 | (05) | MN |
5625505 | (05) | NJ |
64050743 | (05) | KY |
F69218 | (02) |