Healthcare Provider Details

I. General information

NPI: 1396072468
Provider Name (Legal Business Name): MAGDY KHALIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 EAST NINTH AVENUE SIERRA VISTA HOSPITAL
TRUTH OR CONSEQUENCES NM
87901
US

IV. Provider business mailing address

800 EAST NINTH AVENUE SIERRA VISTA HOSPITAL
TRUTH OR CONSEQUENCES NM
87901
US

V. Phone/Fax

Practice location:
  • Phone: 575-743-1205
  • Fax: 575-894-7659
Mailing address:
  • Phone: 575-743-1205
  • Fax: 575-894-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2011-0015
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: