Provider Demographics
NPI:1518078807
Name:MACKENZIE, JOHN FRAZER (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FRAZER
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5874
Mailing Address - Fax:928-458-2039
Practice Address - Street 1:1001 WILLOW CREEK RD STE 3300
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1614
Practice Address - Country:US
Practice Address - Phone:928-778-0827
Practice Address - Fax:928-778-5622
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0863520OtherBCBS
AZ377920Medicaid
AZG44190Medicare UPIN
AZ377920Medicaid