Provider Demographics
NPI:1679953053
Name:MCKENZIE, JULIE BLACK (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:BLACK
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:16172 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-8959
Mailing Address - Country:US
Mailing Address - Phone:970-423-8840
Mailing Address - Fax:970-423-8850
Practice Address - Street 1:16172 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-8959
Practice Address - Country:US
Practice Address - Phone:970-423-8840
Practice Address - Fax:970-423-8850
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0057620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine