Healthcare Provider Details

I. General information

NPI: 1992068563
Provider Name (Legal Business Name): DANIEL LEE MAGRO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9047 POPLAR AVE STE 105
GERMANTOWN TN
38138-6401
US

IV. Provider business mailing address

1211 UNION AVE STE 330
MEMPHIS TN
38104-6655
US

V. Phone/Fax

Practice location:
  • Phone: 901-752-2300
  • Fax: 901-752-2367
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52761
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: