Provider Demographics
NPI:1811930431
Name:MCKENZIE, HEATHER A (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:A
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5730
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5700
Mailing Address - Country:US
Mailing Address - Phone:888-402-7256
Mailing Address - Fax:888-902-1099
Practice Address - Street 1:8811 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5415
Practice Address - Country:US
Practice Address - Phone:210-297-2520
Practice Address - Fax:210-297-2539
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6110208100000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165949204Medicaid
8BB450OtherBCBS
TX6023560OtherCIGNA
TX7527630OtherAETNA
TX8K6279OtherBCBS
TX8K6279OtherBCBS
TX7527630OtherAETNA
TX6023560OtherCIGNA