Provider Demographics
NPI:1922291897
Name:MAGEE, GARY K (LMT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:K
Last Name:MAGEE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12815 US HIGHWAY 98 W
Mailing Address - Street 2:SUITE 114
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32550-3209
Mailing Address - Country:US
Mailing Address - Phone:850-837-2002
Mailing Address - Fax:
Practice Address - Street 1:12815 US HIGHWAY 98 W
Practice Address - Street 2:SUITE 114
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32550-3209
Practice Address - Country:US
Practice Address - Phone:850-837-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0028796174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist