Provider Demographics
NPI:1104953546
Name:MCKENZIE, JAMIE E (MD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:E
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:E
Other - Last Name:POTOSEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 TAMPA GENERAL CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3571
Mailing Address - Country:US
Mailing Address - Phone:813-844-7000
Mailing Address - Fax:813-844-4705
Practice Address - Street 1:10740 PALM RIVER RD STE 360
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4578
Practice Address - Country:US
Practice Address - Phone:813-844-7585
Practice Address - Fax:813-844-5877
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH20282207RH0003X
MA236446207RH0003X
MEMD22848207RH0003X
FLME148507207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60326945OtherSTATE LICENSE