Organization
KEITH A MACKENZIE DO PC
Active
Other names
MacKenzie Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE QUINN (CREDENTIALING/BILLING SUPERVISOR)
(928) 541-1312
Entity
Organization
Contact information
Practice address
3190 CLEARWATER DR, PRESCOTT, AZ 86305-7131
(928) 541-1312
(928) 541-0002
Mailing address
3190 CLEARWATER DR, PRESCOTT, AZ 86305-7131
(928) 541-1312
(928) 541-0002
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
3225
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390766
—
AZ
Enumeration date
06/09/2009
Last updated
10/18/2017
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