Individual
DR. KEITH ANDREW MACKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3190 CLEARWATER DR, PRESCOTT, AZ 86305-7131
(928) 541-1312
(928) 541-0002
Mailing address
PO BOX 11208, PRESCOTT, AZ 86304-1208
(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
06/21/2005
Last updated
04/25/2012
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