Provider Demographics
NPI:1497955777
Name:MACKENZIE, PAUL JAMES (MD PHD FRCSC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAMES
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:MD PHD FRCSC
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Mailing Address - Street 1:1040 NW 22ND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3057
Mailing Address - Country:US
Mailing Address - Phone:503-413-8202
Mailing Address - Fax:503-413-7006
Practice Address - Street 1:1040 NW 22ND AVE FL 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-413-8202
Practice Address - Fax:503-413-7006
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR27380207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology