1437107190 NPI number — MR. EDWARD J MAGEE M.D.

Table of content: MR. EDWARD J MAGEE M.D. (NPI 1437107190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437107190 NPI number — MR. EDWARD J MAGEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGEE
Provider First Name:
EDWARD
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437107190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 WILLISTON PARK PT
Provider Second Line Business Mailing Address:
SUITE #2050
Provider Business Mailing Address City Name:
LAKE MARY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32746-2172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-829-8960
Provider Business Mailing Address Fax Number:
407-829-8978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 WILLISTON PARK PT
Provider Second Line Business Practice Location Address:
SUITE #2050
Provider Business Practice Location Address City Name:
LAKE MARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-2172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-829-8960
Provider Business Practice Location Address Fax Number:
407-829-8978
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME88467 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 297957 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 562499046 . This is a "FHHS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 562499046 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7384706 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9825037 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 562499046 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 64364 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 014612300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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