Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD0000193Z5 | WA |
NPI | 1063410512 |
---|---|
Provider Name | Patrick C Maginn |
First Address | Longview, WA 98632-2464 |
Second Address | Longview, WA 98632-2464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 22/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115655 | MEDICARE (01) | OR |
1819002 | (05) | WA |
A16070 | (02) |