Provider Demographics
NPI:1083805758
Name:MACKAY, BRENDAN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:JAMES
Last Name:MACKAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MCNEEL LN
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6054
Mailing Address - Country:US
Mailing Address - Phone:308-534-6655
Mailing Address - Fax:308-534-6662
Practice Address - Street 1:215 MCNEEL LN
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6054
Practice Address - Country:US
Practice Address - Phone:308-534-6655
Practice Address - Fax:308-534-6662
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2723207X00000X, 207XS0106X
NE28077207X00000X, 207XS0106X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1628009Medicare PIN