Provider Demographics
NPI:1669672739
Name:MAGER, JUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MAGER
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 1:239 MILLER AVE
Mailing Address - Street 2:#8
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2841
Mailing Address - Country:US
Mailing Address - Phone:415-730-4235
Mailing Address - Fax:415-952-9345
Practice Address - Street 1:239 MILLER AVE
Practice Address - Street 2:#8
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2841
Practice Address - Country:US
Practice Address - Phone:415-730-4235
Practice Address - Fax:415-952-9345
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine