Gary Mackman, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

12411 Issued in AZ

Practice address

1130 E Missouri Ave
Ste 100
Phoenix, AZ 85014-2718

Phone

(602) 995-1166

Fax

(602) 995-2390

NPI assigned

Jun 25, 2005

Last updated

Oct 9, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Gary Mackman Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Arizona Retina and Vitreous Consultants LLC

  • Ophthalmology Physician
  • Phoenix, AZ
  • NPI 1174852388
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349740800000",
    "number": "1326044108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 E MISSOURI AVE",
            "address_2": "STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850142718",
            "telephone_number": "602-995-1166",
            "fax_number": "602-995-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 E MISSOURI AVE",
            "address_2": "STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850142718",
            "telephone_number": "602-995-1166",
            "fax_number": "602-995-2390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKMAN",
        "first_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-25",
        "last_updated": "2012-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "AZ",
            "license": "12411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "860220938",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GARY",
            "last_name": "MACKMAN",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Janice Lee Mackie, RN
• Tessa Anne Mackiewicz
• Jo-Ann M. Mackinnon, CRNA
• Cathy Macklin, LPN
• Justin Macklin, O.D.
• Nathan Macknight, DPT
• Nan Maclean, PMHNP
• Pamela Macleod, PMHNP-BC
• Kathleen S Macluer, PA, OT
• Kaya Malene Macmillan, DHSC, MPAS, PA-C

• Ophthalmology Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Ophthalmology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 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.

Verify at the official NPI Registry.