Provider Demographics
NPI:1447477708
Name:DOUGLAS J. MACKENZIE, M.D., INC.
Entity type:Organization
Organization Name:DOUGLAS J. MACKENZIE, M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-898-0700
Mailing Address - Street 1:1722 STATE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2458
Mailing Address - Country:US
Mailing Address - Phone:805-898-0700
Mailing Address - Fax:805-898-0600
Practice Address - Street 1:1722 STATE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2458
Practice Address - Country:US
Practice Address - Phone:805-898-0700
Practice Address - Fax:805-898-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA486832086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174557623OtherINDIVIDUAL PROVIDER#
CAA48683OtherCA LICS
CA=========OtherCA TAX ID
CAX55433Medicare UPIN
CAW15076Medicare PIN