Provider Demographics
NPI:1609056183
Name:MACKENZIE, JOHN FRASER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRASER
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-4002
Mailing Address - Country:US
Mailing Address - Phone:504-365-9100
Mailing Address - Fax:504-365-1731
Practice Address - Street 1:2018 8TH ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-4002
Practice Address - Country:US
Practice Address - Phone:504-365-9100
Practice Address - Fax:504-365-1731
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011214207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology