Provider Demographics
NPI:1275691727
Name:MAGIDSON, PAUL R (CRNA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:MAGIDSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-587-4044
Mailing Address - Fax:502-479-1425
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2877
Practice Address - Country:US
Practice Address - Phone:502-587-4203
Practice Address - Fax:502-587-4155
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3000344367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200018890AMedicaid
KY74289174Medicaid
KY00546034Medicare Oscar/Certification
KYP00612975Medicare PIN