Provider Demographics
NPI:1821046772
Name:MACKEY, VERNON THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:THOMAS
Last Name:MACKEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9191 W THUNDERBIRD RD
Mailing Address - Street 2:D-101
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4270
Mailing Address - Country:US
Mailing Address - Phone:623-977-6700
Mailing Address - Fax:623-977-6771
Practice Address - Street 1:9191 W THUNDERBIRD RD
Practice Address - Street 2:D-101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4270
Practice Address - Country:US
Practice Address - Phone:623-977-6700
Practice Address - Fax:623-977-6771
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3535207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD47266Medicare UPIN
AZZ85776Medicare ID - Type Unspecified