Provider Demographics
NPI:1497825798
Name:MACKIE, SCOTT PAUL (MD)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:PAUL
Last Name:MACKIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HUFFMAN ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515
Mailing Address - Country:US
Mailing Address - Phone:907-345-2050
Mailing Address - Fax:907-345-9807
Practice Address - Street 1:3710 WOODLAND ROAD
Practice Address - Street 2:SUITE 1100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517
Practice Address - Country:US
Practice Address - Phone:907-248-1122
Practice Address - Fax:907-248-4168
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD12291Medicaid
AKMD12295Medicaid
AKMD12294Medicaid
AK000WCHHSCMedicare ID - Type Unspecified
AKMD12295Medicaid
AKMD12291Medicaid