Individual
JOSEPH R MACKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A. - C
Contact information
Practice address
INTERSTATE MEDICAL OFFICE SOUTH, 3500 N. INTERSTATE AVE., PORTLAND, OR 97227-1196
(503) 285-9321
Mailing address
1215 22ND AVE., LONGVIEW, WA 98632-2823
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00326
OR
363AM0700X
Medical Physician Assistant
PA10001610
WA
Other
Enumeration date
09/25/2006
Last updated
07/08/2007
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