Individual
JOHN MARSHALL MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
016357
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2176021
—
LA
01
—
4Q803F600
MEDICARE - PTAN
LA
Enumeration date
09/13/2006
Last updated
06/07/2013
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