Individual
DR. CLARK R MCKENZIE
Active
Individual
DR. CLARK R MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
R4P62
MO
207RI0011X
Interventional Cardiology Physician
Primary
R4P62
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000047049
MCARE CCL GROUP NUMBER
MO
01
—
004013185
MEDICARE PROV ID AREA 99
MO
01
—
006012762
MEDICARE PROVIDER ID
—
01
—
110171721
RR MEDICARE NUMBER
MO
01
—
1124011010
HHC CATH GROUP NPI
MO
01
—
1801889795
STL GROUP NPI
MO
01
—
1881863009
FARM GROUP NPI
MO
01
—
CD6536
RR GROUP 01
MO
01
—
CI7050
RR GROUP 99
MO
01
—
MA1080
CCL GROUP NUMBER
MO
01
—
MA1080001
CCL INDIVDUAL PROV NUMBER
MO
01
—
P00275849
RR CCL GROUP
MO
Enumeration date
08/25/2005
Last updated
01/19/2016
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