Provider Demographics
NPI:1003831462
Name:MCKENZIE, ALLAN DEE (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:DEE
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4523 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3858
Mailing Address - Country:US
Mailing Address - Phone:501-663-2336
Mailing Address - Fax:501-669-2362
Practice Address - Street 1:4523 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-663-2363
Practice Address - Fax:501-663-2362
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2674768OtherUNITED HEALTHCARE
AR06080012300OtherQUALCHOICE
AR764178OtherHEALTHLINK
AR7203815OtherAETNA
AR162394001Medicaid
AR06080012300OtherQUALCHOICE
AR764178OtherHEALTHLINK
AR7203815OtherAETNA