MEDICARE: DR. PAUL KENT MCGAHA D.O.

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	2083P0901X	Public Health & General Preventive Medicine Physician	G8621	TX

General Provider Information

NPI Number	:	1639271588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL KENT MCGAHA D.O.

Provider Business Mailing Address
First Line	:	3606 FLAGSTONE DR
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75707-1642
Country	:	US
Telephone Number	:	903-533-5264
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 W FRONT ST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75702-7822
Country	:	US
Telephone Number	:	903-533-5264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/09/2007

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