Healthcare Provider Details

I. General information

NPI: 1558523241
Provider Name (Legal Business Name): JOSEPH MAGLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 GRIFFIN AVE
ENUMCLAW WA
98022-2369
US

IV. Provider business mailing address

40402 292ND AVE SE
ENUMCLAW WA
98022-9767
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-6511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60306035
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0300042
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerL&I
# 2
IdentifierG8911875
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerMEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: