Provider Demographics
NPI:1184824971
Name:MCKINZIE, RACHEL RAE (DO)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:RAE
Last Name:MCKINZIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:401 S COLTRANE RD STE 280
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6722
Mailing Address - Country:US
Mailing Address - Phone:405-341-6223
Mailing Address - Fax:
Practice Address - Street 1:4401 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3413
Practice Address - Country:US
Practice Address - Phone:918-392-2944
Practice Address - Fax:918-664-2521
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4713207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200231520AMedicaid
OKOKA106049Medicare PIN