Provider Demographics
NPI:1164772281
Name:MCKENZIE, SHELDON JUNIOR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:JUNIOR
Last Name:MCKENZIE
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 1:1844 SW TOPAZ LN
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-5406
Mailing Address - Country:US
Mailing Address - Phone:301-613-5663
Mailing Address - Fax:
Practice Address - Street 1:520 SW RAMSEY AVENUE
Practice Address - Street 2:SUITE 205
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-0001
Practice Address - Country:US
Practice Address - Phone:541-507-2140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175393207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism