Provider Demographics
NPI:1174557623
Name:MACKENZIE, DOUGLAS JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JOSEPH
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MEDICAL CENTER PKWY STE 400410
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2567
Mailing Address - Country:US
Mailing Address - Phone:805-729-2302
Mailing Address - Fax:
Practice Address - Street 1:1800 MEDICAL CENTER PKWY STE 400410
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2567
Practice Address - Country:US
Practice Address - Phone:805-729-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN650202086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA48683AMedicare PIN
X55433Medicare UPIN