Individual
DR. GARY MACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1130 E MISSOURI AVE, STE 100, PHOENIX, AZ 85014-2718
(602) 995-1166
(602) 995-2390
Mailing address
1130 E MISSOURI AVE, STE 100, PHOENIX, AZ 85014-2718
(602) 995-1166
(602) 995-2390
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
12411
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
860220938
TAX ID
AZ
Enumeration date
06/25/2005
Last updated
10/09/2012
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