Provider Demographics
NPI:1144518689
Name:MACKEY, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:MACKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1801 DIAMOND ST UNIT 3-216
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3326
Mailing Address - Country:US
Mailing Address - Phone:619-372-2272
Mailing Address - Fax:
Practice Address - Street 1:524 BROADWAY, SUITE G
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-9191
Practice Address - Country:US
Practice Address - Phone:619-425-8212
Practice Address - Fax:619-425-1604
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC168077208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice