Joseph R Mackenzie, P.A. - C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA00326 Issued in OR

Practice address

Interstate Medical Office South
3500 N. Interstate Ave.
Portland, OR 97227-1196

Phone

(503) 285-9321

NPI assigned

Sep 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Roger Mackenzie Moore Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619077187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 22ND AVE.",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "INTERSTATE MEDICAL OFFICE SOUTH",
            "address_2": "3500 N. INTERSTATE AVE.",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271196",
            "telephone_number": "503-285-9321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKENZIE",
        "first_name": "JOSEPH",
        "middle_name": "R",
        "credential": "P.A. - C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA00326",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10001610",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROGER",
            "last_name": "MOORE",
            "middle_name": "MACKENZIE",
            "credential": "R.N.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kelli Mackay, MSW
• Kimberly Mackay, PHARM.D.
• Alexandra M Mackenzie, OTR/L, CHT
• Ariel Mackenzie
• Jennifer Mackenzie
• Kelsey Alene Mackenzie, IBCLC
• Lauren S Mackenzie, CNM
• Lue Ann Mackenzie, MLS
• Marisa Mackenzie
• Paul James Mackenzie, M.D. PH.D. FRCSC

• Medical Physician Assistant in Portland, OR
• Providers in Portland, OR by specialty
• Medical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.