Active NPI
Nicol Ian Mackenzie, MD
- Anesthesiology Physician
- Monterey, CA
National Provider Identifier
1205857174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- G50107
- Practice address
- 23625 Holman Highway
Monterey, CA 93940-5902 - Phone
- (831) 624-5311
- NPI assigned
- Jul 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | G50107 | CA | Primary |
Addresses
Primary practice location
23625 Holman Highway
Monterey, CA 93940-5902
Mailing address
PO Box 7096
Stockton, CA 95267-0096
Phone (209) 956-7725
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50107 | CA | MD | General Practice Dentistry |
| G50107 | CA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326067200000",
"number": "1205857174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7096",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952670096",
"telephone_number": "209-956-7725",
"fax_number": "209-956-7733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23625 HOLMAN HIGHWAY",
"city": "MONTEREY",
"state": "CA",
"postal_code": "939405902",
"telephone_number": "831-624-5311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKENZIE",
"first_name": "NICOL",
"middle_name": "IAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-23",
"last_updated": "2012-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CA",
"license": "G50107",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monterey, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.