Provider Demographics
NPI:1730235797
Name:MACKEY, TIMOTHY WRAY (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WRAY
Last Name:MACKEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 TRUMAN AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3141
Mailing Address - Country:US
Mailing Address - Phone:305-296-4399
Mailing Address - Fax:
Practice Address - Street 1:540 TRUMAN AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3141
Practice Address - Country:US
Practice Address - Phone:305-296-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9185207R00000X
OH34.008213207R00000X
CA20A 9382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI26288Medicare UPIN