Provider Demographics
NPI:1679582522
Name:MCKENZIE, STEPHEN E (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
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:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:BIEBER
Mailing Address - State:CA
Mailing Address - Zip Code:96009-0277
Mailing Address - Country:US
Mailing Address - Phone:530-335-5457
Mailing Address - Fax:530-294-5801
Practice Address - Street 1:37491 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4379
Practice Address - Country:US
Practice Address - Phone:530-335-5457
Practice Address - Fax:530-294-5801
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A540490Medicaid
CAG09284Medicare UPIN
CA00A540490Medicaid