Provider Demographics
NPI:1841392644
Name:MCKENZIE, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:121 N 20TH ST STE 19
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5456
Mailing Address - Country:US
Mailing Address - Phone:334-749-8146
Mailing Address - Fax:334-737-6432
Practice Address - Street 1:121 N 20TH ST STE 19
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5456
Practice Address - Country:US
Practice Address - Phone:334-749-8146
Practice Address - Fax:334-737-6432
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL11317208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
340012694OtherRAILROAD MEDICARE
AL510-28676OtherBCBS OPELIKA
AL529700320Medicaid
AL000026423Medicare PIN
AL529700320Medicaid