Healthcare Provider Details

I. General information

NPI: 1043340185
Provider Name (Legal Business Name): CHRISTINA BRAY MAGILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 E MERIDIAN LOOP STE E
WASILLA AK
99654-7273
US

IV. Provider business mailing address

PO BOX 75045
CHICAGO IL
60675-5045
US

V. Phone/Fax

Practice location:
  • Phone: 907-600-0030
  • Fax: 907-206-7153
Mailing address:
  • Phone: 907-600-0030
  • Fax: 907-206-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2006028765
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberMEDS7503
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: