Provider Demographics
NPI:1649222183
Name:MAGSARILI, KARL (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:
Last Name:MAGSARILI
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:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0670
Mailing Address - Country:US
Mailing Address - Phone:503-656-5273
Mailing Address - Fax:503-650-4828
Practice Address - Street 1:1001 MOLALLA AVE STE 100
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-3753
Practice Address - Country:US
Practice Address - Phone:503-656-5273
Practice Address - Fax:503-650-4828
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR911768081OtherHEALTHNET
OR3004113-15OtherBLUE CROSS HMO
5966733OtherAETNA
OR151106Medicaid
911768081OtherUNITED HEALTHCARE
069013011OtherBLUE CROSS/BLUE SHIELD
911768081OtherODS
ORR133454Medicare PIN
OR3004113-15OtherBLUE CROSS HMO