Provider Demographics
NPI:1801826037
Name:MAGEE, DAVID KA (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KA
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 1:203 SOUTH BLOOMINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745
Mailing Address - Country:US
Mailing Address - Phone:479-770-0728
Mailing Address - Fax:479-770-0712
Practice Address - Street 1:203 SOUTH BLOOMINGTON STREET
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745
Practice Address - Country:US
Practice Address - Phone:479-770-0728
Practice Address - Fax:479-770-0712
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3918208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157893001Medicaid
AR5M798Medicare ID - Type Unspecified
H42286Medicare UPIN
AR157893001Medicaid