Individual
THOMAS PETER MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
924 S FAIRMONT AVE, LODI, CA 95240-5119
(209) 334-2590
Mailing address
10470 OLD PLACERVILLE RD STE 100, SACRAMENTO, CA 95827-2539
(800) 470-0071
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G68077
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200008575
RAILROAD MEDICARE
CA
05
—
GR0029390
—
CA
Enumeration date
10/03/2006
Last updated
06/11/2019
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