Individual
DR. JERRY LAMONT MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1720 E BROAD ST, MANSFIELD, TX 76063-3400
(817) 453-5912
Mailing address
4400 OAK PARK LN, FORT WORTH, TX 76109-9534
(817) 985-7772
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
E-8969
AR
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
R4786
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/23/2012
Last updated
12/11/2024
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