Basic Information
| Provider Information | |||||||||
| NPI: | 1770787418 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRUCE A MACKEY MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3957 E COVELL RD | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730346909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052857246 | ||||||||
| FaxNumber: | 4052857546 | ||||||||
| Practice Location | |||||||||
| Address1: | 3957 E COVELL RD | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730346909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052857246 | ||||||||
| FaxNumber: | 4052857546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 09/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | MACKEY | ||||||||
| AuthorizedOfficialFirstName: | BRUCE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4052857246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 16205 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.