Provider Demographics
NPI:1639271588
Name:MCGAHA, PAUL KENT (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENT
Last Name:MCGAHA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 FLAGSTONE DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-1642
Mailing Address - Country:US
Mailing Address - Phone:903-533-5264
Mailing Address - Fax:
Practice Address - Street 1:1517 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-7822
Practice Address - Country:US
Practice Address - Phone:903-533-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG86212083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA67403Medicare UPIN