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NPI Code Detail

MEDICARE: CARL ROBERT MAGNESS M.D.

MEDICARE: CARL ROBERT MAGNESS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QA0505XAdult Medicine PhysicianC4954AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1926497965OTHERARDRIVERS LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548345606
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARL ROBERT MAGNESS M.D.
Provider Business Mailing Address
First Line : 102 W DICKSON ST
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72701-5219
Country : US
Telephone Number : 479-521-1114
Fax Number : 479-521-2540
Provider Business Practice Location Address
First Line : 102 W DICKSON ST
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72701-5219
Country : US
Telephone Number : 479-521-1114
Fax Number : 479-521-2540
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 05/15/2015

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