Healthcare Provider Details

I. General information

NPI: 1801826037
Provider Name (Legal Business Name): DAVID K.A. MAGEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SOUTH BLOOMINGTON STREET
LOWELL AR
72745
US

IV. Provider business mailing address

203 SOUTH BLOOMINGTON STREET
LOWELL AR
72745
US

V. Phone/Fax

Practice location:
  • Phone: 479-770-0728
  • Fax: 479-770-0712
Mailing address:
  • Phone: 479-770-0728
  • Fax: 479-770-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberE3918
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: