Individual
JOHN PAUL MCKENZIE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
660 W BROADWAY, GLENDALE, CA 91204-1008
(818) 542-9420
(818) 243-9605
Mailing address
660 W BROADWAY, GLENDALE, CA 91204-1008
(818) 542-9420
(818) 243-9605
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
G71752
CA
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
G71752
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G717520
—
CA
01
—
G71752
STATE LICENSE
CA
Enumeration date
01/20/2006
Last updated
08/14/2015
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