Provider Demographics
NPI:1407146137
Name:DONALD MACKENZIE,MD,P.A.
Entity Type:Organization
Organization Name:DONALD MACKENZIE,MD,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-867-3121
Mailing Address - Street 1:3700 W 15TH ST
Mailing Address - Street 2:SUITE 100C
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4736
Mailing Address - Country:US
Mailing Address - Phone:972-867-3121
Mailing Address - Fax:972-867-0564
Practice Address - Street 1:3700 W 15TH ST
Practice Address - Street 2:SUITE 100C
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4736
Practice Address - Country:US
Practice Address - Phone:972-867-3121
Practice Address - Fax:972-867-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA02127Medicare UPIN