Provider Demographics
NPI:1790931426
Name:MACKIE, BRIAN (DVM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:MACKIE
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 OLD WINERY PLACE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827
Mailing Address - Country:US
Mailing Address - Phone:916-362-3111
Mailing Address - Fax:916-362-0190
Practice Address - Street 1:9801 OLD WINERY PL
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1700
Practice Address - Country:US
Practice Address - Phone:916-362-3111
Practice Address - Fax:916-362-0190
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5946-050174M00000X
CAVET 15864174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian