Provider Demographics
NPI: | 1922029263 |
---|---|
Name: | GARRY W MAGOUIRK MDPC |
Entity Type: | Organization |
Organization Name: | GARRY W MAGOUIRK MDPC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | GARRY |
Authorized Official - Middle Name: | W |
Authorized Official - Last Name: | MAGOUIRK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 205-932-3891 |
Mailing Address - Street 1: | 110 23RD ST NW |
Mailing Address - Street 2: | |
Mailing Address - City: | FAYETTE |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 35555-1001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 205-932-3891 |
Mailing Address - Fax: | 205-932-3996 |
Practice Address - Street 1: | 110 23RD ST NW |
Practice Address - Street 2: | |
Practice Address - City: | FAYETTE |
Practice Address - State: | AL |
Practice Address - Zip Code: | 35555-1001 |
Practice Address - Country: | US |
Practice Address - Phone: | 205-932-3891 |
Practice Address - Fax: | 205-932-3996 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-22 |
Last Update Date: | 2013-02-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AL | 00010435 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |