Individual
TRAVIS TODD MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4401 HARRISON BLVD, OGDEN, UT 84403
(801) 387-2800
Mailing address
5444 S GREEN ST, MURRAY, UT 84123-5632
(801) 313-4110
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
10246349-1204
UT
2085R0204X
Vascular & Interventional Radiology Physician
Primary
10246349-1204
UT
Other
Enumeration date
04/02/2012
Last updated
09/26/2018
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