Healthcare Provider Details

I. General information

NPI: 1437107190
Provider Name (Legal Business Name): EDWARD J MAGEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 02/09/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WILLISTON PARK PT SUITE #2050
LAKE MARY FL
32746-2172
US

IV. Provider business mailing address

910 WILLISTON PARK PT SUITE #2050
LAKE MARY FL
32746-2172
US

V. Phone/Fax

Practice location:
  • Phone: 407-829-8960
  • Fax: 407-829-8978
Mailing address:
  • Phone: 407-829-8960
  • Fax: 407-829-8978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME88467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: