Healthcare Provider Details

I. General information

NPI: 1013990654
Provider Name (Legal Business Name): JOSE J MALAGON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S CHARLES G SEIVERS BLVD
CLINTON TN
37716-3916
US

IV. Provider business mailing address

102 S CHARLES G SEIVERS BLVD
CLINTON TN
37716-3916
US

V. Phone/Fax

Practice location:
  • Phone: 865-457-4702
  • Fax: 865-457-7178
Mailing address:
  • Phone: 865-457-4702
  • Fax: 865-457-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000027104
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: