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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	00K94W	OTHER	TX	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	531478	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417151986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN E MCGONAGLE MD PA

Provider Business Mailing Address
First Line	:	763 N GRAHAM ST
Second Line	:
City	:	STEPHENVILLE
State	:	TX
Zip	:	76401-3148
Country	:	US
Telephone Number	:	254-965-4944
Fax Number	:	254-965-5373

Provider Business Practice Location Address
First Line	:	763 N GRAHAM ST
Second Line	:
City	:	STEPHENVILLE
State	:	TX
Zip	:	76401-3148
Country	:	US
Telephone Number	:	254-965-4944
Fax Number	:	254-965-5373

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

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	06/30/2008

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Directions to “MARTIN E MCGONAGLE MD PA ” Practice Location

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