# LODI ORTHOPAEDIC MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Thomas P McKenzie MD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962490078
- **Authorized official:** DR. THOMAS PETER MCKENZIE MD (PRESIDENT)
- **Authorized official phone:** (209) 334-2590

## Contact information

- **Practice address:** 924 S FAIRMONT AVE, LODI, CA 95240-5119
- **Practice address phone:** (209) 334-2590
- **Practice address fax:** (209) 334-0944
- **Mailing address:** 924 S FAIRMONT AVE, LODI, CA 95240-5119
- **Mailing address phone:** (209) 334-2590
- **Mailing address fax:** (209) 334-0944

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/12/2005
- **Last updated:** 04/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 200008575 | RAILROAD MEDICARE | CA |
| 05 | — | GR0029390 | — | CA |