Provider Demographics
NPI:1073572780
Name:MAGOON, MICHAEL RAYNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAYNARD
Last Name:MAGOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:134 BLUE BONNET BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4629
Mailing Address - Country:US
Mailing Address - Phone:210-862-6064
Mailing Address - Fax:
Practice Address - Street 1:120 E HARRIS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5904
Practice Address - Country:US
Practice Address - Phone:325-658-1511
Practice Address - Fax:210-930-4504
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ4899207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CR994OtherBCBS