MEDICARE: DR. MARTIN EUGENE MCGONAGLE M.D.

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	207Y00000X	Otolaryngology Physician	G6563	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

General Provider Information

NPI Number	:	1871698308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN EUGENE MCGONAGLE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 33648
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76162
Country	:	US
Telephone Number	:	817-579-2660
Fax Number	:	817-579-2663

Provider Business Practice Location Address
First Line	:	763 N GRAHAM ST
Second Line	:
City	:	STEPHENVILLE
State	:	TX
Zip	:	76401-3148
Country	:	US
Telephone Number	:	254-965-7870
Fax Number	:	254-965-5373

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/26/2017

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