Provider Demographics
NPI:1013990654
Name:MALAGON, JOSE J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:J
Last Name:MALAGON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 S CHARLES G SEIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-3916
Mailing Address - Country:US
Mailing Address - Phone:865-457-4702
Mailing Address - Fax:865-457-7178
Practice Address - Street 1:102 S CHARLES G SEIVERS BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3916
Practice Address - Country:US
Practice Address - Phone:865-457-4702
Practice Address - Fax:865-457-7178
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3096631Medicaid
G18084Medicare UPIN
TN3096631Medicare PIN