Provider Demographics
NPI:1366646424
Name:MAGAS, LOUIS THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:THOMAS
Last Name:MAGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8791 CONFERENCE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5822
Mailing Address - Country:US
Mailing Address - Phone:239-938-3500
Mailing Address - Fax:
Practice Address - Street 1:6311 SOUTH POINTE BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4901
Practice Address - Country:US
Practice Address - Phone:239-938-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1013612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00652432OtherRR MCR
FL000120500Medicaid
FL52068OtherBC BS OF FLORIDA
FLP00652412OtherRR MCR
FL000120500Medicaid
FLAL803YMedicare PIN