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General NPI Number Information
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NPI Number | 1144541202
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Entity Type | Individual
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Provider Name | MAGDALA POON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 08/07/2015
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Provider Practice Location Address
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Address Line | 2800 E BROAD ST SUITE 504
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City | MANSFIELD
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State | TX
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Zip | 76063-6409
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Country | US
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Telephone | 817-225-0410
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Fax | 817-453-8866
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Provider Business Mailing Address
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Address Line | 2800 E BROAD ST SUITE 504
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City | MANSFIELD
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State | TX
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Zip | 76063-6409
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Country | US
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Telephone | 817-225-0410
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Fax | 817-453-8866
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | BP10037312
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | Q0539
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License Number State | TX
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