Basic Information
| Provider Information | |||||||||
| NPI: | 1891799821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACKEY | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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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: | 06/08/2005 | ||||||||
| LastUpdateDate: | 09/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 16205 | OK | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.