1447477708 NPI number — DOUGLAS J. MACKENZIE, M.D., INC.

Table of content: (NPI 1447477708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447477708 NPI number — DOUGLAS J. MACKENZIE, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS J. MACKENZIE, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PACIFIC PLASTIC SURGERY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447477708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1722 STATE ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93101-2458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-898-0700
Provider Business Mailing Address Fax Number:
805-898-0600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1722 STATE ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93101-2458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-898-0700
Provider Business Practice Location Address Fax Number:
805-898-0600
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MACKENZIE
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-898-0700

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  A48683 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1174557623 . This is a "INDIVIDUAL PROVIDER#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A48683 . This is a "CA LICS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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