Provider Demographics
NPI:1568556959
Name:MCKENZIE, RICHARD D, (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D,
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3811 COMMONS AVE NE
Mailing Address - Street 2:CONCENTRA MEDICAL CENTER
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5832
Mailing Address - Country:US
Mailing Address - Phone:505-345-9599
Mailing Address - Fax:505-998-4207
Practice Address - Street 1:3811 COMMONS AVE NE
Practice Address - Street 2:CONCENTRA MEDICAL CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5832
Practice Address - Country:US
Practice Address - Phone:505-345-9599
Practice Address - Fax:505-998-4207
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-08-11
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Provider Licenses
StateLicense IDTaxonomies
NM93106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
94577Medicare PIN