Individual
RODERICK JOHN MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
141 WEB DRIVE SUITE 300, DAVENPORT, FL 33837
(863) 422-0020
(863) 422-0021
Mailing address
141 WEB DRIVE SUITE 300, DAVENPORT, FL 33837
(863) 422-0020
(863) 422-0021
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1758
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134202856
NPI
FL
01
—
1992785513
GROUP NPI
FL
01
—
21281
MEDICARE GROUP
FL
01
—
21281A
MEDICARE GROUP
FL
Enumeration date
10/24/2006
Last updated
12/06/2023
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