Healthcare Provider Details

I. General information

NPI: 1811382955
Provider Name (Legal Business Name): JAMIE DON MAGAR ATP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 WILSHIRE AVE NE
ALBUQUERQUE NM
87113-2569
US

IV. Provider business mailing address

5501 WILSHIRE AVE NE
ALBUQUERQUE NM
87113-2569
US

V. Phone/Fax

Practice location:
  • Phone: 505-338-6100
  • Fax: 505-359-6774
Mailing address:
  • Phone: 505-338-6100
  • Fax: 505-359-6774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: