Provider Demographics
NPI:1992068563
Name:MAGRO, DANIEL LEE JR (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:MAGRO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT # 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-367-9001
Mailing Address - Fax:901-565-8787
Practice Address - Street 1:3725 CHAMPION HILLS DR
Practice Address - Street 2:SUITE 2000
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2597
Practice Address - Country:US
Practice Address - Phone:901-367-9001
Practice Address - Fax:901-565-8787
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2015-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN52761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ014205Medicaid
TN5442003OtherBCBS
TNQ014205Medicaid