Provider Demographics
NPI:1780795153
Name:MACKAY, DEWEY C III (MD)
Entity type:Individual
Prefix:DR
First Name:DEWEY
Middle Name:C
Last Name:MACKAY
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302
Mailing Address - Country:US
Mailing Address - Phone:435-723-1747
Mailing Address - Fax:435-723-6851
Practice Address - Street 1:950 SO MEDICAL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302
Practice Address - Country:US
Practice Address - Phone:435-723-1747
Practice Address - Fax:435-723-6851
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT1605811205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C18653Medicare UPIN
UT000060418Medicare PIN