Provider Demographics
NPI:1376537977
Name:MAGEE, ROBERT WALTER (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WALTER
Last Name:MAGEE
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 1:1325 MELISSA LN
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2878
Mailing Address - Country:US
Mailing Address - Phone:731-571-1065
Mailing Address - Fax:
Practice Address - Street 1:1950 COOK ST
Practice Address - Street 2:SUITE F
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1899
Practice Address - Country:US
Practice Address - Phone:731-882-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD011499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4458883OtherCIGNA
0140441OtherUNITED HEALTHCARE
116247OtherBETTER HEALTH PLAN
7153OtherTLC(MEMPHIS MANAGED CARE)
TN3803066Medicaid
020085100OtherPALMETTO GBA
5347162OtherAETNA
TN3038973OtherBLUE CROSS
4458883OtherCIGNA
TN3803069Medicare PIN