Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN14615 | FL |
Y | 213EG0000X | General Practice | DN14615 | FL |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN14615 | FL |
NPI | 1043428782 |
---|---|
Provider Name | James Magee III |
First Address | Eustis, FL 32726-2908 |
Second Address | Eustis, FL 32726-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 28/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
691972396 | (05) | FL |
DN14615 | STATE LICENSE (01) | FL |