Provider Demographics
NPI:1558402172
Name:MAGEE, WILLIAM EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWIN
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 1:2975 FRISCO HILL RD
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-2008
Mailing Address - Country:US
Mailing Address - Phone:636-942-2489
Mailing Address - Fax:314-982-3486
Practice Address - Street 1:2975 FRISCO HILL RD
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-2008
Practice Address - Country:US
Practice Address - Phone:636-942-2489
Practice Address - Fax:314-982-3486
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1115207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA11207Medicare UPIN
MO4625Medicare ID - Type Unspecified