Individual
DR. LESLIE MCKENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2538
(601) 815-1854
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2538
(601) 815-1854
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
17105
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125062
—
MS
01
—
P00618859
RAILROAD MEDICARE
MS
01
—
P01236765
RAILROAD MEDICARE PTAN
MS
Enumeration date
07/13/2006
Last updated
01/07/2014
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