Provider Demographics
NPI:1396855946
Name:FAWZY, MAGDA (MD)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:
Last Name:FAWZY
Suffix:
Gender:F
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:PO BOX 99213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0213
Mailing Address - Country:US
Mailing Address - Phone:682-885-4446
Mailing Address - Fax:817-810-1396
Practice Address - Street 1:2727 E SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6613
Practice Address - Country:US
Practice Address - Phone:682-885-6000
Practice Address - Fax:682-885-6026
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1431208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0050NCOtherBCBSTX GRP PIN
TX1640359OtherCCN PIN
TX4043747OtherAETNA PIN
1912978891OtherGRP NPI NUMBER
TX12686008Medicaid
TX170994101Medicaid
TX100297967OtherAMERIGROUP PIN
TX112554100OtherFIRSTCARE PIN
TX1640359OtherFIRSTHEALTH PIN
TX080626701Medicaid
TX126586006Medicaid
TX163314101Medicaid
TX2793448OtherCIGNA PIN
TX413453OtherPHCS PIN
TX126586007Medicaid
TX88B2075OtherBCBSTX IND PIN
TX163314101Medicaid