Healthcare Provider Details

I. General information

NPI: 1639261720
Provider Name (Legal Business Name): ROY WAYNE MCGAHEE R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 FARM ROAD 2297
SULPHUR SPRINGS TX
75482-4719
US

IV. Provider business mailing address

472 FARM ROAD 2297
SULPHUR SPRINGS TX
75482-4719
US

V. Phone/Fax

Practice location:
  • Phone: 903-439-6085
  • Fax: 903-439-0462
Mailing address:
  • Phone: 903-439-6085
  • Fax: 903-439-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberR20353
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: