Provider Demographics
NPI:1629040910
Name:MCKENZIE, GREGORY GENE (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:GENE
Last Name:MCKENZIE
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 1:551 HILL COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6085
Mailing Address - Country:US
Mailing Address - Phone:830-377-5359
Mailing Address - Fax:830-896-7020
Practice Address - Street 1:551 HILL COUNTRY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6085
Practice Address - Country:US
Practice Address - Phone:830-377-5359
Practice Address - Fax:830-896-7020
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3235207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0999914-04Medicaid
TX110002127OtherRR MEDICARE
TX099991402Medicaid
TX110002127OtherRR MEDICARE
TX099991402Medicaid