Doctor Name: | RODERICK MCKENZIE |
NPI Number: | 1134202856 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | PA1758 |
Business Practice Address: | 1200 S Main St Suite 200 Belle Glade, FL - 334307808 |
Business Phone Number: | 5619962024 |
Business Fax Number: | 5619928020 |
Mailing Address: | 1200 S Main St, Suite 200 BELLE GLADE |
State: | FL |
Postal Code: | 334307808 |
Phone Number: | 5619962024 |
Fax Number: | 5619928020 |
NPI Enumeration Date: | 10/24/2006 |
NPI Last Update Date: | 06/21/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA1758 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |