Provider Demographics
NPI:1114926276
Name:MACKENZIE, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:MACKENZIE
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 1:5038 TENNYSON PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2954
Mailing Address - Country:US
Mailing Address - Phone:972-403-3121
Mailing Address - Fax:972-403-3109
Practice Address - Street 1:5038 TENNYSON PKWY STE B
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2954
Practice Address - Country:US
Practice Address - Phone:972-403-3121
Practice Address - Fax:972-403-3109
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-03-28
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
TXH1138207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A02127Medicare UPIN