Provider Demographics
NPI:1417261991
Name:MAGUCHI ALDRETE, MEGUMI (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGUMI
Middle Name:
Last Name:MAGUCHI ALDRETE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGUMI
Other - Middle Name:
Other - Last Name:MAGUCHI ALDRETE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9013 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-9416
Mailing Address - Country:US
Mailing Address - Phone:850-912-8020
Mailing Address - Fax:850-912-8150
Practice Address - Street 1:9013 UNIVERSITY PKWY
Practice Address - Street 2:SUITE G
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-9416
Practice Address - Country:US
Practice Address - Phone:850-912-8020
Practice Address - Fax:850-912-8150
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA246313207Q00000X
FLME111022207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006478100Medicaid
AL592-24332OtherBCBS OF ALABAMA
FL14L17OtherBSBS OF FLORIDA
AL592-24332OtherBCBS OF ALABAMA