Provider Demographics
NPI:1285938977
Name:MAGUIRE, ALISTER (LMT)
Entity type:Individual
Prefix:
First Name:ALISTER
Middle Name:
Last Name:MAGUIRE
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 1:278 IDAHO ST APT 19
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-7902
Mailing Address - Country:US
Mailing Address - Phone:541-227-3191
Mailing Address - Fax:
Practice Address - Street 1:250 OAK ST STE 5
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1855
Practice Address - Country:US
Practice Address - Phone:541-227-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17546174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist