MEDICARE: MARTIN E MCGONAGLE MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332S00000X	Hearing Aid Equipment		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	531518	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1144355892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN E MCGONAGLE MD PA

Provider Business Mailing Address
First Line	:	510 E HWY 377
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76048-2556
Country	:	US
Telephone Number	:	817-579-2662
Fax Number	:	817-579-2663

Provider Business Practice Location Address
First Line	:	107 S PARK DR
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5951
Country	:	US
Telephone Number	:	325-643-5824
Fax Number	:	325-643-1256

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARTIN E MCGONAGLE
Credential	:	MD, PA
Telephone Number	:	254-965-7870

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	06/30/2008

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