Provider Demographics
NPI:1285625764
Name:MAGAS, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MAGAS
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:PO BOX 215
Mailing Address - Street 2:902 HIGHWAY 13 SOUTH
Mailing Address - City:COLLINWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:38450-0215
Mailing Address - Country:US
Mailing Address - Phone:931-724-9135
Mailing Address - Fax:931-724-4572
Practice Address - Street 1:902 HIGHWAY 13 S
Practice Address - Street 2:
Practice Address - City:COLLINWOOD
Practice Address - State:TN
Practice Address - Zip Code:38450-4614
Practice Address - Country:US
Practice Address - Phone:931-724-9135
Practice Address - Fax:931-724-4572
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3028029Medicaid
TNB58992Medicare UPIN
TN3028029Medicare PIN