Provider Demographics
NPI:1942569231
Name:GOODWIN, MACKENZIE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:LEE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MACKENZIE
Other - Middle Name:LEE
Other - Last Name:BEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1893 E MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3827
Mailing Address - Country:US
Mailing Address - Phone:228-273-9021
Mailing Address - Fax:
Practice Address - Street 1:MACKENZIE GOODWIN MD DBA WASATCH SURGICAL LLC
Practice Address - Street 2:520 MEDICAL DR STE 300
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010
Practice Address - Country:US
Practice Address - Phone:228-273-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11768709-1205208600000X, 2086X0206X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11768709-1205OtherLICENSE