Provider Demographics
NPI:1629787015
Name:LABIB, MAGY (PA-C)
Entity Type:Individual
Prefix:
First Name:MAGY
Middle Name:
Last Name:LABIB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 GRANGE HALL DR APT 5217
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-1950
Mailing Address - Country:US
Mailing Address - Phone:806-407-6611
Mailing Address - Fax:
Practice Address - Street 1:5017 HERITAGE AVE STE 102
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5995
Practice Address - Country:US
Practice Address - Phone:817-545-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
TXPA16057363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty