Provider Demographics
NPI:1326060682
Name:MCKENZIE, WILLIAM TONY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TONY
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 1:1397 JENKS AVE # 1
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2442
Mailing Address - Country:US
Mailing Address - Phone:850-522-5864
Mailing Address - Fax:850-522-5863
Practice Address - Street 1:1397 JENKS AVE # 1
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2442
Practice Address - Country:US
Practice Address - Phone:850-522-5864
Practice Address - Fax:850-522-5863
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0093485174400000X, 207RS0012X
FLME00934585207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273178900Medicaid
FLME0093485OtherMEDICAL LICENSE NUMBER
FLME0093485OtherMEDICAL LICENSE NUMBER
FLH56468Medicare UPIN
FLBM8706814OtherDEA